Provider Demographics
NPI:1265533020
Name:THE HOME MEDICAL EQUIPMENT & SUPPLY STORE
Entity type:Organization
Organization Name:THE HOME MEDICAL EQUIPMENT & SUPPLY STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-7160
Mailing Address - Street 1:4377 HUGH HOWELL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4706
Mailing Address - Country:US
Mailing Address - Phone:770-939-7160
Mailing Address - Fax:
Practice Address - Street 1:4377 HUGH HOWELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4706
Practice Address - Country:US
Practice Address - Phone:770-939-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA628610947AMedicaid
GA5821300001Medicare NSC