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General NPI Number Information
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NPI Number | 1487670410
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Entity Type | Organization
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Legal Business Name | NOURISIAN MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 PEACHTREE ST NW
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City | ATLANTA
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State | GA
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Zip | 30309-2449
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Country | US
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Telephone | 800-761-0809
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 921602
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City | NORCROSS
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State | GA
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Zip | 30010-1602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | DR. TAMADIS YOUNG
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Credential |
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Telephone | 18007610809
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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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