Provider Demographics
NPI:1407035348
Name:APALACHEE MEDICAL SUPPLY & MOBILITY
Entity Type:Organization
Organization Name:APALACHEE MEDICAL SUPPLY & MOBILITY
Other - Org Name:PRIOR NAME (NORTH GEORGIA MEDICAL EQUIPMENT AND SUPPLIES EIN (26-12089
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-374-7999
Mailing Address - Street 1:PO BOX 1314
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1314
Mailing Address - Country:US
Mailing Address - Phone:678-374-7999
Mailing Address - Fax:866-282-7808
Practice Address - Street 1:1106 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9236
Practice Address - Country:US
Practice Address - Phone:706-629-3320
Practice Address - Fax:706-629-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-28
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1835332B00000X
GA3532332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA963714326AMedicaid
GA963714326AMedicaid