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General NPI Number Information
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NPI Number | 1356693436
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Entity Type | Organization
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Legal Business Name | ATLANTIC MEDICAL, LLC
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 915 FERNCLIFF CV STE 1A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-2420
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Country | US
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Telephone | 855-722-8526
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Fax | 855-239-6226
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Provider Business Mailing Address
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Address Line | 915 FERNCLIFF CV STE 1A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-2420
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Country | US
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Telephone | 855-722-8526
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Fax | 855-239-6226
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JUSTIN FERREIRA
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Credential |
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Telephone | 855-722-8526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | F11493
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | F12216
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | F12216
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License Number State | MS
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