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General NPI Number Information
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NPI Number | 1588774392
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Entity Type | Organization
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Legal Business Name | SSC AFFILIATES INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 2020 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1426
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Country | US
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Telephone | 404-350-7743
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Fax | 404-350-7514
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Provider Business Mailing Address
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Address Line | 2020 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1426
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Country | US
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Telephone | 404-350-7743
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Fax | 404-350-7514
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHRISTOPHER PAUL MCGOURK
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Credential | PHARMD
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Telephone | 404-350-7743
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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 | PHRE005987
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE005987
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License Number State | GA
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