Provider Demographics
NPI:1659441517
Name:EAST GEORGIA MEDICAL
Entity Type:Organization
Organization Name:EAST GEORGIA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-559-1180
Mailing Address - Street 1:226 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6140
Mailing Address - Country:US
Mailing Address - Phone:478-559-1180
Mailing Address - Fax:478-559-1176
Practice Address - Street 1:226 OAK ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6140
Practice Address - Country:US
Practice Address - Phone:478-559-1180
Practice Address - Fax:478-559-1176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST GEORGIA RESPICARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies