Provider Demographics
NPI:1770529018
Name:MAXIMUM MEDICAL INC
Entity type:Organization
Organization Name:MAXIMUM MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:DARREL
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-589-7587
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:MIDVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30441
Mailing Address - Country:US
Mailing Address - Phone:478-589-7587
Mailing Address - Fax:478-589-7309
Practice Address - Street 1:1044 MCGARRH MILL POND ROAD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401
Practice Address - Country:US
Practice Address - Phone:478-589-7587
Practice Address - Fax:478-589-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477923Medicaid
LA1477923Medicaid
GA=========OtherBLUE CROSS BLUE SHIELD
GA=========OtherNOVA NET INC
FL=========OtherNOVA NET INC
GA=========OtherNOVA NET INC