Organization
MIJARES MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUEL MIJARES BAUTISTA JR. (CEO)
(404) 436-2070
Entity
Organization
Contact information
Practice address
3276 BUFORD DR STE 104-333, BUFORD, GA 30519-5702
(404) 436-2070
(877) 548-2685
Mailing address
3276 BUFORD DR STE 104-333, BUFORD, GA 30519-5702
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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