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General NPI Number Information
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NPI Number | 1902982184
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Entity Type | Organization
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Legal Business Name | ADVANTAGE HOME MEDICAL EQUIPMENT INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 263 MAIN ST
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 678-957-6503
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Fax |
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Provider Business Mailing Address
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Address Line | 605 HWY 41 NW
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City | JASPER
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State | FL
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Zip | 32052
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Country | US
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Telephone | 386-792-2224
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Fax | 386-792-2244
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIE I BUTLER SR.
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Credential | PRESIDENT
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Telephone | 386-792-2224
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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 | 1175
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License Number State | FL
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