Provider Demographics
NPI:1629705900
Name:FAMILY MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-272-7140
Mailing Address - Street 1:217 ARROWHEAD BLVD STE D2
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1169
Mailing Address - Country:US
Mailing Address - Phone:470-615-7958
Mailing Address - Fax:
Practice Address - Street 1:217 ARROWHEAD BLVD STE D2
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1169
Practice Address - Country:US
Practice Address - Phone:470-615-7958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies