Provider Demographics
NPI:1184866485
Name:MEDICAL SUPPLY AMERICA, LLC
Entity Type:Organization
Organization Name:MEDICAL SUPPLY AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-656-7622
Mailing Address - Street 1:3809 HOLY CROSS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5608
Mailing Address - Country:US
Mailing Address - Phone:678-656-7622
Mailing Address - Fax:
Practice Address - Street 1:3809 HOLY CROSS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5608
Practice Address - Country:US
Practice Address - Phone:678-656-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies