Provider Demographics
NPI:1396856399
Name:DART MEDICAL, INC
Entity Type:Organization
Organization Name:DART MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-835-4740
Mailing Address - Street 1:2718 BRICKTON NORTH DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9100
Mailing Address - Country:US
Mailing Address - Phone:678-835-4740
Mailing Address - Fax:678-835-4742
Practice Address - Street 1:2718 BRICKTON NORTH DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-9100
Practice Address - Country:US
Practice Address - Phone:678-835-4740
Practice Address - Fax:678-835-4742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DART HEALTH GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4779270001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4779270001Medicare NSC