Provider Demographics
NPI:1326282567
Name:KAY ONE SOURCE LLC
Entity Type:Organization
Organization Name:KAY ONE SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-683-7248
Mailing Address - Street 1:1911 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6824
Mailing Address - Country:US
Mailing Address - Phone:678-683-7248
Mailing Address - Fax:770-948-8144
Practice Address - Street 1:1911 DAVID DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6824
Practice Address - Country:US
Practice Address - Phone:678-683-7248
Practice Address - Fax:770-948-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies