Provider Demographics
NPI:1649386483
Name:CERTIFIED RESPIRATORY SERVICES,INC.
Entity Type:Organization
Organization Name:CERTIFIED RESPIRATORY SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-366-9226
Mailing Address - Street 1:429 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0108
Mailing Address - Country:US
Mailing Address - Phone:912-366-9226
Mailing Address - Fax:912-366-8265
Practice Address - Street 1:429 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0108
Practice Address - Country:US
Practice Address - Phone:912-366-9226
Practice Address - Fax:912-366-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000698046AMedicaid
GA1058410001Medicare NSC