MEDICARE: KAY'S MEDICAL SUPPLIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BD1200X	Dialysis Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1093197055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY'S MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	950 HERRINGTON RD
Second Line	:	STE C175
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-7217
Country	:	US
Telephone Number	:	770-875-9329
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 HERRINGTON RD
Second Line	:	STE C175
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-7217
Country	:	US
Telephone Number	:	770-875-9329
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAYODE OKUSI
Credential	:
Telephone Number	:	770-875-9329

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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