MEDICARE: AMERITA SOUTH ATLANTIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	335G00000X	Medical Foods Supplier
4	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174488	OTHER		NCPDP

General Provider Information

NPI Number	:	1780224030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERITA SOUTH ATLANTIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 223017
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-2017
Country	:	US
Telephone Number	:	800-477-7375
Fax Number	:	877-676-0493

Provider Business Practice Location Address
First Line	:	3355 BRECKINRIDGE BLVD STE 120
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4989
Country	:	US
Telephone Number	:	770-500-3834
Fax Number	:	833-994-0847

Authorized Official
Title or Position	:	CFO
Name	:	ALEX KATEN
Credential	:
Telephone Number	:	800-477-7375

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/02/2026

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Directions to “AMERITA SOUTH ATLANTIC LLC ” Practice Location

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