Provider Demographics
NPI:1467639450
Name:MAXIMUM MEDICAL SE, INC.
Entity Type:Organization
Organization Name:MAXIMUM MEDICAL SE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-589-7587
Mailing Address - Street 1:1044 MCGARRH MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4110
Mailing Address - Country:US
Mailing Address - Phone:478-589-7587
Mailing Address - Fax:
Practice Address - Street 1:1044 MCGARRH MILL POND RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4110
Practice Address - Country:US
Practice Address - Phone:478-589-7587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies