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General NPI Number Information
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NPI Number | 1740414150
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Entity Type | Organization
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Legal Business Name | MEDLIFE MEDICAL SUPPLY & EQUIPMENT, LLC
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW SUITE 304
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-564-4796
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Fax | 404-564-4797
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Provider Business Mailing Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW SUITE 304
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-564-4796
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Fax | 404-564-4797
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. CHRISTINE D BROWN
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Credential |
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Telephone | 404-564-4796
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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 | GA
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