Provider Demographics
NPI:1497080162
Name:WAALS MEDICAL SUPPY AND EQUIPMENT
Entity Type:Organization
Organization Name:WAALS MEDICAL SUPPY AND EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-389-6364
Mailing Address - Street 1:45 CREEKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-2548
Mailing Address - Country:US
Mailing Address - Phone:404-389-6364
Mailing Address - Fax:
Practice Address - Street 1:45 CREEKSIDE TRL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-2548
Practice Address - Country:US
Practice Address - Phone:404-389-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies