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General NPI Number Information
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NPI Number | 1477198604
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Entity Type | Organization
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Legal Business Name | KINGDOM C & M DEVICES INC.
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 994 MILLEDGEVILLE RD STE A
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City | EATONTON
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State | GA
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Zip | 31024-7481
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Country | US
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Telephone | 762-220-3460
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Fax | 762-220-3464
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Provider Business Mailing Address
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Address Line | 6350 LAKE OCONEE PKWY STE 110
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City | GREENSBORO
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State | GA
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Zip | 30642-6490
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Country | US
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Telephone | 762-220-3460
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Fax | 762-220-3464
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Authorized Official
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Title or Position | OWNER
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Name | TERESA DIANNE LAWRENCE
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Credential |
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Telephone | 762-220-3460
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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 |
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License Number State |
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