=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992106637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCNURSE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2014
-----------------------------------------------------
Last Update Date | 09/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 SPALDING TRL
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-625-1192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 SPALDING TRL
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-625-1192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ORIEL MCLEAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-625-1192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------