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General NPI Number Information
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NPI Number | 1962642124
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Entity Type | Organization
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Legal Business Name | MEDMART PLUS LLC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 3555 CENTERVILLE HWY STE 103
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City | SNELLVILLE
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State | GA
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Zip | 30039-6457
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Country | US
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Telephone | 770-982-5050
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Fax | 770-982-5053
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Provider Business Mailing Address
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Address Line | 3555 CENTERVILLE HWY SUITE103
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City | SNELLVILLE
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State | GA
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Zip | 30039
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Country | US
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Telephone | 770-982-5050
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Fax | 770-982-5053
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Authorized Official
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Title or Position | PRESDIENT
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Name | CLAUDE ECHOLS
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Credential |
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Telephone | 770-982-5051
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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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