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General NPI Number Information
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NPI Number | 1750529004
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Entity Type | Organization
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Legal Business Name | WESTCY MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 01/24/2009
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Last Update Date | 01/24/2009
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Provider Practice Location Address
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Address Line | 3735 SWEETBRIAR TRCE
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City | SNELLVILLE
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State | GA
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Zip | 30039-5258
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Country | US
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Telephone | 404-316-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 3735 SWEETBRIAR TRCE
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City | SNELLVILLE
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State | GA
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Zip | 30039-5258
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Country | US
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Telephone | 404-316-0332
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARON B EVANS
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Credential |
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Telephone | 404-316-0332
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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 | 09000142
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License Number State | GA
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