Organization
PREMIUM MEDICAL SUPPLY LLC
Active
Organization
PREMIUM MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEYANNA WILLIS (PRESIDENT)
(404) 448-4577
Entity
Organization
Contact information
Practice address
3011 RAINBOW DR STE 303, DECATUR, GA 30034-1681
(404) 448-4577
Mailing address
3011 RAINBOW DR STE 303, DECATUR, GA 30034-1681
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/12/2018
Last updated
12/05/2018
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