MEDICARE: KLEMAKO MEDICAL SUPPLIES INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	8086	GA

General Provider Information

NPI Number	:	1306124144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLEMAKO MEDICAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	3875 POWDER SPRINGS RD
Second Line	:	SUITE D
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2759
Country	:	US
Telephone Number	:	770-222-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	3875 POWDER SPRINGS RD
Second Line	:	SUITE D
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2759
Country	:	US
Telephone Number	:	770-222-3332
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. CLEMENT NWANOLUE
Credential	:
Telephone Number	:	770-222-3332

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	09/21/2011

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