Provider Demographics
NPI:1578733291
Name:GULDMANN SOUTHEAST
Entity Type:Organization
Organization Name:GULDMANN SOUTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DURAND
Authorized Official - Middle Name:HILDRED
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-207-9547
Mailing Address - Street 1:2040 MOUNT VERNON RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4360
Mailing Address - Country:US
Mailing Address - Phone:770-207-9547
Mailing Address - Fax:
Practice Address - Street 1:2040 MOUNT VERNON RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4360
Practice Address - Country:US
Practice Address - Phone:770-207-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment