Organization
KINGDOM MEDICAL SUPPLY LLC
Active
Other names
KINGDOM MEDICAL SUPPLY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA DIANNE LAWRENCE (CEO)
(706) 453-1123
Entity
Organization
Contact information
Practice address
1020 PARK DRIVE, SUITE B, GREENSBORO, GA 30642
(706) 453-1123
(706) 453-1124
Mailing address
1020 PARK DRIVE, SUITE B, GREENSBORO, GA 30647
(706) 453-1123
(706) 453-1124
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
GA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/18/2008
Last updated
12/31/2015
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