Organization
SRUBS UNIFORMS N MORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAUHEEDAH M ROSS MAMMOGRAPHY (TECHINICIAN)
(770) 922-9006
Entity
Organization
Contact information
Practice address
1573 GEORGIA HIGHWAY 20 NE STE 106, CONYERS, GA 30012-8004
(770) 922-9006
(770) 922-9303
Mailing address
1573 GEORGIA HIGHWAY 20 NE STE 106, CONYERS, GA 30012-8004
(770) 922-9006
(770) 922-9303
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
BL-008270
GA
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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