Provider Demographics
NPI:1952136525
Name:RADIANT MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:RADIANT MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-855-4858
Mailing Address - Street 1:2302 PARKLAKE DR NE STE 146
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2956
Mailing Address - Country:US
Mailing Address - Phone:404-855-4858
Mailing Address - Fax:
Practice Address - Street 1:2302 PARKLAKE DR NE STE 146
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2956
Practice Address - Country:US
Practice Address - Phone:404-855-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies