Provider Demographics
NPI:1285681346
Name:FRONTIER MEDICAL EQUIPMENT PROVIDERS
Entity Type:Organization
Organization Name:FRONTIER MEDICAL EQUIPMENT PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ESSIEN
Authorized Official - Last Name:UDORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-484-4334
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-0099
Mailing Address - Country:US
Mailing Address - Phone:770-484-4334
Mailing Address - Fax:770-484-3448
Practice Address - Street 1:7024 ROGERS LAKE RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5175
Practice Address - Country:US
Practice Address - Phone:770-484-4334
Practice Address - Fax:770-484-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA300850141332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1305240001Medicare NSC