Provider Demographics
NPI:1467621375
Name:DUNHAM MEDICAL LLC
Entity Type:Organization
Organization Name:DUNHAM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:770-795-0592
Mailing Address - Street 1:3900 LEGACY PARK BLVD NW
Mailing Address - Street 2:D-300
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7412
Mailing Address - Country:US
Mailing Address - Phone:770-795-0592
Mailing Address - Fax:770-795-1199
Practice Address - Street 1:3900 LEGACY PARK BLVD NW
Practice Address - Street 2:D-300
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7412
Practice Address - Country:US
Practice Address - Phone:770-795-0592
Practice Address - Fax:770-795-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6077350001Medicare NSC