Provider Demographics
NPI:1821852302
Name:EATONTOWN MED SUPPLIES CORP
Entity Type:Organization
Organization Name:EATONTOWN MED SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-734-1116
Mailing Address - Street 1:5300 MEMORIAL DR STE 134
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3155
Mailing Address - Country:US
Mailing Address - Phone:770-734-1116
Mailing Address - Fax:866-537-3112
Practice Address - Street 1:5300 MEMORIAL DR STE 134
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3155
Practice Address - Country:US
Practice Address - Phone:770-734-1116
Practice Address - Fax:866-537-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies