Provider Demographics
NPI:1306358718
Name:ELITE WOUND CARE AND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ELITE WOUND CARE AND MEDICAL SUPPLIES
Other - Org Name:DEMAND MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-595-2200
Mailing Address - Street 1:2498 WASHINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-6600
Mailing Address - Country:US
Mailing Address - Phone:706-595-2200
Mailing Address - Fax:706-597-8703
Practice Address - Street 1:2498 WASHINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-6600
Practice Address - Country:US
Practice Address - Phone:706-595-2200
Practice Address - Fax:706-597-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003206721AMedicaid