Provider Demographics
NPI:1770638470
Name:ENTERPRISING SERVICES MEDICAL UNL.
Entity Type:Organization
Organization Name:ENTERPRISING SERVICES MEDICAL UNL.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-788-1505
Mailing Address - Street 1:3011 RAINBOW DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1681
Mailing Address - Country:US
Mailing Address - Phone:770-788-1505
Mailing Address - Fax:770-234-6260
Practice Address - Street 1:3011 RAINBOW DR
Practice Address - Street 2:SUITE G
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1681
Practice Address - Country:US
Practice Address - Phone:770-788-1505
Practice Address - Fax:770-234-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00204085332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA555650815AMedicaid
GA4813760001Medicare NSC