Organization
XCALIBUR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY RAY FRIERSON (OWNER)
(678) 520-3464
Entity
Organization
Contact information
Practice address
1071 HANOVER DR, MADISON, GA 30650
(678) 500-9542
(678) 500-9543
Mailing address
1071 HANOVER DR, MADISON, GA 30650
(678) 500-9542
(678) 500-9543
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
20170210145
GA
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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