Provider Demographics
NPI:1841471786
Name:ATLANTIC UNIFORMS AND MEDICAL SUPPLIES
Entity type:Organization
Organization Name:ATLANTIC UNIFORMS AND MEDICAL SUPPLIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LINWOOD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-586-0111
Mailing Address - Street 1:100 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850
Mailing Address - Country:US
Mailing Address - Phone:252-586-0111
Mailing Address - Fax:252-586-0115
Practice Address - Street 1:100 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850
Practice Address - Country:US
Practice Address - Phone:252-586-0111
Practice Address - Fax:252-586-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC335E00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704865Medicaid
NC6063430001Medicare NSC