Provider Demographics
NPI:1881995454
Name:PREMIER SHOCKWAVE, INC.
Entity type:Organization
Organization Name:PREMIER SHOCKWAVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STOLARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-256-4440
Mailing Address - Street 1:750 HAMMOND DR NE
Mailing Address - Street 2:BUILDING 18 SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5532
Mailing Address - Country:US
Mailing Address - Phone:404-256-4440
Mailing Address - Fax:404-256-4446
Practice Address - Street 1:750 HAMMOND DR NE
Practice Address - Street 2:BUILDING 18 SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:404-256-4440
Practice Address - Fax:404-256-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies