Provider Demographics
NPI:1770691495
Name:PHILLIP MEDICAL SUPPLIES
Entity type:Organization
Organization Name:PHILLIP MEDICAL SUPPLIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AJOSEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-357-7246
Mailing Address - Street 1:3731 LOCKERBIE LN
Mailing Address - Street 2:SUITE G
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2390
Mailing Address - Country:US
Mailing Address - Phone:678-357-7246
Mailing Address - Fax:678-384-0480
Practice Address - Street 1:3731 LOCKERBIE LN
Practice Address - Street 2:SUITE G
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2390
Practice Address - Country:US
Practice Address - Phone:678-357-7246
Practice Address - Fax:678-384-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies