Provider Demographics
NPI:1497787337
Name:APALACHEE MEDICAL SUPPLY & MOBILITY
Entity type:Organization
Organization Name:APALACHEE MEDICAL SUPPLY & MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-374-7999
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0023
Mailing Address - Country:US
Mailing Address - Phone:678-374-7999
Mailing Address - Fax:678-374-4331
Practice Address - Street 1:1023 LAKE OCONEE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5554
Practice Address - Country:US
Practice Address - Phone:678-374-7999
Practice Address - Fax:678-374-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA464084395AMedicaid
GA464084395AMedicaid