Provider Demographics
NPI:1184656621
Name:ATLANTA OXYGEN AND MEDICAL
Entity Type:Organization
Organization Name:ATLANTA OXYGEN AND MEDICAL
Other - Org Name:ATLANTA OXYGEN AND MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-255-4553
Mailing Address - Street 1:6595 ROSWELL RD NE STE G
Mailing Address - Street 2:STE 228
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3152
Mailing Address - Country:US
Mailing Address - Phone:404-355-4553
Mailing Address - Fax:404-355-2447
Practice Address - Street 1:1746 DEFOOR AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7532
Practice Address - Country:US
Practice Address - Phone:404-355-4553
Practice Address - Fax:404-355-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA332BP3500X, 332BX2000X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00515325AMedicaid
GA52012641OtherBLUE CROSS BLUE SHIELD
4613640001Medicare NSC