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General NPI Number Information
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NPI Number | 1396725818
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Entity Type | Organization
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Legal Business Name | BANDE ENTERPRISES, INC.
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 INDUSTRIAL WAY
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-6814
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Country | US
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Telephone | 770-460-0612
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Fax | 770-460-5114
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Provider Business Mailing Address
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Address Line | 130 INDUSTRIAL WAY
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-6814
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Country | US
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Telephone | 770-460-0612
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Fax | 770-460-5114
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Authorized Official
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Title or Position | VICE PRESIDENT OPERATIONS
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Name | DR. DELBERT LEWIN CARROLL
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Credential | PHD
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Telephone | 770-460-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | GA
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