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General NPI Number Information
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NPI Number | 1518455005
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Entity Type | Organization
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Legal Business Name | J LYNN MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 1691 PHOENIX BLVD STE 280
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City | ATLANTA
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State | GA
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Zip | 30349-5565
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Country | US
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Telephone | 281-738-3055
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Fax | 866-284-6279
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Provider Business Mailing Address
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Address Line | 1691 PHOENIX BLVD STE 280
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City | ATLANTA
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State | GA
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Zip | 30349-5565
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Country | US
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Telephone | 281-738-3055
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Fax | 866-284-6279
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Authorized Official
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Title or Position | PRESIDENT
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Name | LATEESE G. FORD
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Credential |
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Telephone | 281-738-3055
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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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