MEDICARE: AMERICAN MEDICAL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	343900000X	Non-emergency Medical Transport (VAN)
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679745335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN MEDICAL, LLC

Provider Business Mailing Address
First Line	:	4222 RICKENBACKER DR NE UNIT 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3768
Country	:	US
Telephone Number	:	404-788-3442
Fax Number	:	404-252-2584

Provider Business Practice Location Address
First Line	:	4222 RICKENBACKER DR NE UNIT 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3768
Country	:	US
Telephone Number	:	404-788-3442
Fax Number	:	404-252-2584

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. JULIUS ANTHONY BOLTON
Credential	:
Telephone Number	:	404-788-3442

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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