Provider Demographics
NPI:1497870539
Name:GEORGIA OXYGEN PHARMACY
Entity Type:Organization
Organization Name:GEORGIA OXYGEN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-423-7809
Mailing Address - Street 1:611 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-3315
Mailing Address - Country:US
Mailing Address - Phone:229-424-0018
Mailing Address - Fax:
Practice Address - Street 1:9 RUSSELL DR
Practice Address - Street 2:STE 101
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-4001
Practice Address - Country:US
Practice Address - Phone:706-515-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00923348CMedicaid
GA00923348CMedicaid