Provider Demographics
NPI:1407915275
Name:ALLSWELL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ALLSWELL MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:YAW
Authorized Official - Last Name:OPPONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-729-1086
Mailing Address - Street 1:3951 PLEASANTDALE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4256
Mailing Address - Country:US
Mailing Address - Phone:770-729-1086
Mailing Address - Fax:770-729-1059
Practice Address - Street 1:3951 PLEASANTDALE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4256
Practice Address - Country:US
Practice Address - Phone:770-729-1086
Practice Address - Fax:770-729-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00203367332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5807020001Medicare NSC