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General NPI Number Information
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NPI Number | 1598039497
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Entity Type | Organization
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Legal Business Name | ACCESS WHEELCHAIR REPAIR, LLC
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 283 SWANSON DR STE 103
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8547
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Country | US
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Telephone | 770-609-6187
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Fax | 770-558-2077
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Provider Business Mailing Address
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Address Line | 283 SWANSON DR STE 103
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8547
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Country | US
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Telephone | 770-609-6187
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Fax | 770-558-2077
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Authorized Official
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Title or Position | OWNER/OPERATIONS MANAGER
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Name | THERESA HAYES
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Credential | MHRM, BS
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Telephone | 770-609-6187
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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 | 19125027
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License Number State | GA
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