Provider Demographics
NPI:1790520120
Name:DULUTH MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:DULUTH MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAREB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-351-5894
Mailing Address - Street 1:3675 CRESTWOOD PKWY NW STE 409
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5133
Mailing Address - Country:US
Mailing Address - Phone:770-817-7586
Mailing Address - Fax:404-481-2677
Practice Address - Street 1:3675 CRESTWOOD PKWY NW STE 409
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5133
Practice Address - Country:US
Practice Address - Phone:770-817-7586
Practice Address - Fax:404-481-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies