Provider Demographics
NPI:1952901027
Name:GET - WELL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:GET - WELL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-808-5118
Mailing Address - Street 1:6518 HIGHWAY 85 STE G
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5604 WENDY BAGWELL PKWY STE 322
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7814
Practice Address - Country:US
Practice Address - Phone:404-808-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies