Provider Demographics
NPI:1750866174
Name:ENVIP MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ENVIP MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-219-7202
Mailing Address - Street 1:130 EAGLE SPRING CT STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7252
Mailing Address - Country:US
Mailing Address - Phone:478-219-7202
Mailing Address - Fax:478-219-7218
Practice Address - Street 1:130 EAGLE SPRING CT STE D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7252
Practice Address - Country:US
Practice Address - Phone:478-219-7202
Practice Address - Fax:478-219-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies