Provider Demographics
NPI:1881349066
Name:UPJOY MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:UPJOY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-621-5779
Mailing Address - Street 1:2045 MOUNT ZION RD STE 227
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:214-621-5779
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTRY CLUB DR BLDG 100C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7216
Practice Address - Country:US
Practice Address - Phone:404-882-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies