Provider Demographics
NPI:1528191244
Name:GEORGIA DME, INC.
Entity Type:Organization
Organization Name:GEORGIA DME, INC.
Other - Org Name:GEORGIA DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-610-9796
Mailing Address - Street 1:633 19TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1584
Mailing Address - Country:US
Mailing Address - Phone:706-617-0187
Mailing Address - Fax:706-507-3444
Practice Address - Street 1:633 19TH ST STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1584
Practice Address - Country:US
Practice Address - Phone:706-617-0187
Practice Address - Fax:706-507-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA241203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5896330001Medicare NSC