Provider Demographics
NPI:1821096199
Name:PAL HOME DIAGNOSTICS&RESP.CARE
Entity Type:Organization
Organization Name:PAL HOME DIAGNOSTICS&RESP.CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:II
Authorized Official - Credentials:NDT CRTT
Authorized Official - Phone:478-274-1653
Mailing Address - Street 1:1115D HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3555
Mailing Address - Country:US
Mailing Address - Phone:478-274-1653
Mailing Address - Fax:478-274-0895
Practice Address - Street 1:1115D HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3555
Practice Address - Country:US
Practice Address - Phone:478-274-1653
Practice Address - Fax:478-274-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008679333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00978931AMedicaid
GA00978931AMedicaid