Provider Demographics
NPI:1518035781
Name:GENESIS DME, INC
Entity Type:Organization
Organization Name:GENESIS DME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-5200
Mailing Address - Street 1:2501 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6046
Mailing Address - Country:US
Mailing Address - Phone:912-285-5200
Mailing Address - Fax:912-285-9378
Practice Address - Street 1:2501 PLANT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6046
Practice Address - Country:US
Practice Address - Phone:912-285-5200
Practice Address - Fax:912-285-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
GAAT000581335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891096BMedicaid
GA000891096AMedicaid
4144260001Medicare NSC