Provider Demographics
NPI:1164701330
Name:SRUBS UNIFORMS N MORE
Entity Type:Organization
Organization Name:SRUBS UNIFORMS N MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TAUHEEDAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MAMMOGRAPHY
Authorized Official - Phone:770-922-9006
Mailing Address - Street 1:1573 GEORGIA HIGHWAY 20 NE STE 106
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-8004
Mailing Address - Country:US
Mailing Address - Phone:770-922-9006
Mailing Address - Fax:770-922-9303
Practice Address - Street 1:1573 GEORGIA HIGHWAY 20 NE STE 106
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-8004
Practice Address - Country:US
Practice Address - Phone:770-922-9006
Practice Address - Fax:770-922-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABL-008270332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment