Provider Demographics
NPI:1083944482
Name:JLC MEDICAL, INC
Entity Type:Organization
Organization Name:JLC MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:MITCHEL
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-973-9518
Mailing Address - Street 1:2041 KERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4370
Mailing Address - Country:US
Mailing Address - Phone:770-973-9518
Mailing Address - Fax:770-973-8463
Practice Address - Street 1:2041 KERRY CREEK DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4370
Practice Address - Country:US
Practice Address - Phone:770-973-9518
Practice Address - Fax:770-973-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2009#75736332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment