Provider Demographics
NPI:1437576568
Name:BLUE WATER MEDICAL, INC.
Entity Type:Organization
Organization Name:BLUE WATER MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-355-5398
Mailing Address - Street 1:922 GAINESLVILLE HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:770-355-5398
Mailing Address - Fax:888-974-6246
Practice Address - Street 1:922 GAINESVILLE HWY
Practice Address - Street 2:SUITE 112
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1642
Practice Address - Country:US
Practice Address - Phone:770-355-5398
Practice Address - Fax:888-974-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7202360001OtherDMERC