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General NPI Number Information
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NPI Number | 1396742532
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Entity Type | Organization
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Legal Business Name | AMERISOUTH MOBILITY, LLC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26 EXECUTIVE PARK W SUITE 2603
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City | ATLANTA
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State | GA
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Zip | 30329-2202
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Country | US
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Telephone | 404-321-5500
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Fax | 404-321-5530
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Provider Business Mailing Address
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Address Line | 26 EXECUTIVE PARK W SUITE 2603
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City | ATLANTA
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State | GA
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Zip | 30329-2202
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Country | US
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Telephone | 404-321-5500
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Fax | 404-321-5530
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JASON ALLEN DANNENBERG
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Credential |
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Telephone | 404-321-5500
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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 | K931128
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License Number State | GA
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