Provider Demographics
NPI:1407900509
Name:HOMETOWN MEDICAL, INC.
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-924-5225
Mailing Address - Street 1:205 W LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3544
Mailing Address - Country:US
Mailing Address - Phone:229-924-5225
Mailing Address - Fax:229-924-5006
Practice Address - Street 1:205 W LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3544
Practice Address - Country:US
Practice Address - Phone:229-924-5225
Practice Address - Fax:229-924-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000727328BMedicaid
GA000727328AMedicaid
GA1112410001Medicare ID - Type Unspecified