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General NPI Number Information
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NPI Number | 1609799121
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Entity Type | Organization
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Legal Business Name | MINT MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/01/2026
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Provider Practice Location Address
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Address Line | 220 BAUMGARD WAY
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City | LOCUST GROVE
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State | GA
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Zip | 30248-4473
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Country | US
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Telephone | 678-365-1379
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Fax |
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Provider Business Mailing Address
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Address Line | 220 BAUMGARD WAY
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City | LOCUST GROVE
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State | GA
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Zip | 30248-4473
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Country | US
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Telephone | 678-365-1379
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM OLIVER HANSFORD
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Credential |
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Telephone | 678-365-1379
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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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