Provider Demographics
NPI:1477552859
Name:SOUTHERN MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:SOUTHERN MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RESPIRATORY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:404-874-0082
Mailing Address - Street 1:573 JUNIPER ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2387
Mailing Address - Country:US
Mailing Address - Phone:404-874-0082
Mailing Address - Fax:404-874-2666
Practice Address - Street 1:573 JUNIPER ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2387
Practice Address - Country:US
Practice Address - Phone:404-874-0082
Practice Address - Fax:404-874-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077086LGB332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00770327CMedicaid
GA00770327AMedicaid
GA00770327AMedicaid