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General NPI Number Information
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NPI Number | 1346707791
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Entity Type | Organization
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Legal Business Name | MED SUPPLIES EXPRESS INC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 925 CRIPPLE CREEK DR STE 500
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8504
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Country | US
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Telephone | 678-377-5660
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Fax | 770-454-0123
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Provider Business Mailing Address
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Address Line | 925 CRIPPLE CREEK DR STE 500
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8504
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Country | US
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Telephone | 678-377-5660
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Fax | 770-454-0123
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Authorized Official
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Title or Position | OWNER
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Name | MBAUKWU ANABA
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Credential |
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Telephone | 678-377-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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