MEDICARE: RADIANT MEDICAL SUPPLIES 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

General Provider Information

NPI Number	:	1952136525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	2302 PARKLAKE DR NE STE 146
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2956
Country	:	US
Telephone Number	:	404-855-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 PARKLAKE DR NE STE 146
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2956
Country	:	US
Telephone Number	:	404-855-4858
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AYSHA PENNERMAN
Credential	:
Telephone Number	:	404-855-4858

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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Directions to “RADIANT MEDICAL SUPPLIES LLC ” Practice Location

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