Organization
SOUTHERN MEDICAL SUPPLY
Active
Organization
SOUTHERN MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA CARROLL (OFFICE MANAGER)
(706) 861-7303
Entity
Organization
Contact information
Practice address
91 CRYE LEIKE DR, FORT OGLETHORPE, GA 30742-4055
(706) 861-7303
(706) 861-0201
Mailing address
PO BOX 5513, FORT OGLETHORPE, GA 30742-0713
(706) 861-7303
(706) 861-0201
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
957
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00434662A
—
GA
Enumeration date
10/09/2006
Last updated
08/22/2020
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