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General NPI Number Information
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NPI Number | 1508722869
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Entity Type | Organization
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Legal Business Name | PURDY MEDICAL WIGS & DME SUPPLIER LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 5801 ROCK SPRINGS RD
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City | LITHONIA
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State | GA
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Zip | 30038-1504
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Country | US
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Telephone | 678-439-8319
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Fax | 770-200-1620
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Provider Business Mailing Address
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Address Line | 5801 ROCK SPRINGS RD
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City | LITHONIA
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State | GA
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Zip | 30038-1504
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Country | US
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Telephone | 678-439-8319
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Fax | 770-200-1620
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA ROSS
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Credential |
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Telephone | 678-439-8319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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