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General NPI Number Information
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NPI Number | 1497100317
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Entity Type | Organization
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Legal Business Name | GRACE-GARANTHE MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 2400 WISTERIA DR SUITE F
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City | SNELLVILLE
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State | GA
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Zip | 30078-2689
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Country | US
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Telephone | 770-441-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 WISTERIA DR SUITE F
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City | SNELLVILLE
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State | GA
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Zip | 30078-2689
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Country | US
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Telephone | 770-441-9992
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Fax |
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Authorized Official
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Title or Position | AUTHORIZE OFFICIAL
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Name | MS. RANTI HERNANDEZ
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Credential |
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Telephone | 770-441-9992
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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 | 298593
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License Number State | GA
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