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Organization
MERCY MEDICAL SUPPLY LLC
Active
Organization
MERCY MEDICAL SUPPLY LLC
Active
Parent organization
MERCY MEDICAL SUPPLY, LLC
Other names
Mercy Medical Supply, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERCY MEDICAL SUPPLY, LLC
Authorized official
MS. JACQUELINE KAY JOHNSON (PRESIDENT/OWNER)
(770) 506-9944
Entity
Organization
Contact information
Practice address
3584 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281
(770) 506-9944
(770) 506-9921
Mailing address
3584 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281-4171
(770) 506-9944
(770) 506-9921
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076482217A
—
GA
Enumeration date
09/10/2008
Last updated
08/31/2018
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