Provider Demographics
NPI:1518286202
Name:EPW ENTERPRISE LLC
Entity Type:Organization
Organization Name:EPW ENTERPRISE LLC
Other - Org Name:EPW GLOBAL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:LESHELLE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-838-9011
Mailing Address - Street 1:3686 LOWER CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135
Mailing Address - Country:US
Mailing Address - Phone:678-838-9011
Mailing Address - Fax:
Practice Address - Street 1:3686 LOWER CREEK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4291
Practice Address - Country:US
Practice Address - Phone:678-838-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPW ENTERPRISE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20171332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies