Organization
TRI-STATE HOME MEDICAL
Active
Organization
TRI-STATE HOME MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK H MILLS SR. RPH9642 REGISTERED P (OWNER VICE PRESIDENT)
(229) 524-8911
Entity
Organization
Contact information
Practice address
801 N WILEY AVE, DONALSONVILLE, GA 39845
(229) 524-8911
(229) 524-2300
Mailing address
PO BOX 157, 801 N. WILEY AVENUE, DONALSONVILLE, GA 39845-0157
(229) 524-8911
(229) 524-2300
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000922237AB
—
GA
Enumeration date
09/14/2006
Last updated
12/13/2011
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