Provider Demographics
NPI:1497134811
Name:DIAPER DEPOT, INC.
Entity Type:Organization
Organization Name:DIAPER DEPOT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-297-4900
Mailing Address - Street 1:5231 MEMORIAL DR
Mailing Address - Street 2:B3
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3153
Mailing Address - Country:US
Mailing Address - Phone:404-297-4900
Mailing Address - Fax:404-297-4905
Practice Address - Street 1:5231 MEMORIAL DR
Practice Address - Street 2:B3
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3153
Practice Address - Country:US
Practice Address - Phone:404-297-4900
Practice Address - Fax:404-297-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies