Provider Demographics
NPI:1508556713
Name:ACWORTH DURABLE MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:ACWORTH DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC
Authorized Official - Phone:678-471-6983
Mailing Address - Street 1:124 VALLEY FARM LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1777
Mailing Address - Country:US
Mailing Address - Phone:678-471-6983
Mailing Address - Fax:678-403-2310
Practice Address - Street 1:4929 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5323
Practice Address - Country:US
Practice Address - Phone:678-471-6983
Practice Address - Fax:678-403-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies