Provider Demographics
NPI:1487860532
Name:NRC MEDICALS SUPPLIES, LLC
Entity Type:Organization
Organization Name:NRC MEDICALS SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:TIPTON
Authorized Official - Last Name:KWAKUMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-985-1989
Mailing Address - Street 1:368 W PIKE ST
Mailing Address - Street 2:SUITE 204 B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3240
Mailing Address - Country:US
Mailing Address - Phone:678-985-1989
Mailing Address - Fax:770-755-5682
Practice Address - Street 1:368 W PIKE ST
Practice Address - Street 2:SUITE 204 B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3240
Practice Address - Country:US
Practice Address - Phone:678-985-1989
Practice Address - Fax:770-755-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20019192637332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies