MEDICARE: DAMON POPE CHOICE MEDICAL

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		GA

General Provider Information

NPI Number	:	1568567378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON POPE CHOICE MEDICAL

Provider Business Mailing Address
First Line	:	4774 LAMB AVE
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-1121
Country	:	US
Telephone Number	:	706-486-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	4774 LAMB AVE
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-1121
Country	:	US
Telephone Number	:	706-486-0055
Fax Number	:	706-486-0060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	11/14/2007

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Directions to “ DAMON POPE CHOICE MEDICAL ” Practice Location

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