Provider Demographics
NPI:1417718958
Name:CHEROKEE DME INC.
Entity Type:Organization
Organization Name:CHEROKEE DME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-369-3020
Mailing Address - Street 1:2959 CHEROKEE ST NW STE 103E
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6522
Mailing Address - Country:US
Mailing Address - Phone:404-369-3020
Mailing Address - Fax:404-905-5202
Practice Address - Street 1:2959 CHEROKEE ST NW STE 103E
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6522
Practice Address - Country:US
Practice Address - Phone:404-369-3020
Practice Address - Fax:404-905-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies