=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477343952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KELLI SADLER MEDICAL SUPPLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1165 PENNEFEATHER LN
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-4714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-851-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1165 PENNEFEATHER LN
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-4714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-851-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KELLI SADLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-851-8504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------