Provider Demographics
NPI:1407827116
Name:RELIANCE MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:RELIANCE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-210-9567
Mailing Address - Street 1:337 S BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8865
Mailing Address - Country:US
Mailing Address - Phone:706-210-9567
Mailing Address - Fax:
Practice Address - Street 1:337 SOUTH BELAIR RD.
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8865
Practice Address - Country:US
Practice Address - Phone:706-210-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1468Medicaid
GA00838505AMedicaid
GA1261370001Medicare ID - Type Unspecified