Provider Demographics
NPI:1790439099
Name:MG MEDICAL EQUIPMENT AND SUPPLY LLC
Entity Type:Organization
Organization Name:MG MEDICAL EQUIPMENT AND SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-490-3911
Mailing Address - Street 1:660 E CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1312
Mailing Address - Country:US
Mailing Address - Phone:770-490-3911
Mailing Address - Fax:678-823-7129
Practice Address - Street 1:660 E CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1312
Practice Address - Country:US
Practice Address - Phone:770-490-3911
Practice Address - Fax:678-823-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies