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General NPI Number Information
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NPI Number | 1821023425
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Entity Type | Organization
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Legal Business Name | VICTORIAN MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1016 HOWELL MILL RD NW #1210
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City | ATLANTA
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State | GA
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Zip | 30318-5559
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Country | US
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Telephone | 770-843-5380
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Fax |
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Provider Business Mailing Address
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Address Line | 2566 SHALLOWFORD RD NE SUITE 104-143
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City | ATLANTA
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State | GA
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Zip | 30345-1202
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Country | US
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Telephone | 770-843-5380
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. ADAM HARRIS
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Credential |
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Telephone | 770-843-5380
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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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