MEDICARE: C & W DURABLE MEDICAL EQUIPMENT

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1457628190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & W DURABLE MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	1057 MAIN ST
Second Line	:	SUITE C
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1482
Country	:	US
Telephone Number	:	404-362-6901
Fax Number	:	404-362-6904

Provider Business Practice Location Address
First Line	:	1057 MAIN ST
Second Line	:	SUITE C
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1482
Country	:	US
Telephone Number	:	404-362-6901
Fax Number	:	404-362-6904

Authorized Official
Title or Position	:	OWNER
Name	:	RAY WAYNE CRISP
Credential	:
Telephone Number	:	404-362-2990

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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