Provider Demographics
NPI:1477198604
Name:KINGDOM C & M DEVICES INC.
Entity Type:Organization
Organization Name:KINGDOM C & M DEVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-220-3460
Mailing Address - Street 1:6350 LAKE OCONEE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-6490
Mailing Address - Country:US
Mailing Address - Phone:762-220-3460
Mailing Address - Fax:762-220-3464
Practice Address - Street 1:994 MILLEDGEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-7481
Practice Address - Country:US
Practice Address - Phone:762-220-3460
Practice Address - Fax:762-220-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies