MEDICARE: PHYSICIANS CHOICE DME & DIAGNOSTIC SERVICES, 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	332B00000X	Durable Medical Equipment & Medical Supplies	CHIRO7059	GA

General Provider Information

NPI Number	:	1588922363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS CHOICE DME & DIAGNOSTIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	5835 CAMPBELLTON RD SW STE 204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8014
Country	:	US
Telephone Number	:	404-692-1474
Fax Number	:	404-393-9872

Provider Business Practice Location Address
First Line	:	5835 CAMPBELLTON RD SW STE 204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8014
Country	:	US
Telephone Number	:	404-692-1474
Fax Number	:	404-393-9872

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAWN GERARD JONES
Credential	:	D.C.
Telephone Number	:	404-692-1474

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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