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General NPI Number Information
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NPI Number | 1801438676
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Entity Type | Organization
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Legal Business Name | OLIVE CARE DURABLE MEDICAL & SUPPLIES, LLC.
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 123 S. MAIN ST.
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City | REIDSVILLE
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State | GA
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Zip | 30453
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Country | US
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Telephone | 912-557-1084
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Fax | 912-557-1086
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Provider Business Mailing Address
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Address Line | 185 PERKINS HENDRIX RD
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City | COLLINS
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State | GA
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Zip | 30421-3008
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Country | US
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Telephone | 912-314-8415
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KARISHA MARIE AMMONS
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Credential |
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Telephone | 912-314-8415
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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 |
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