Organization
4SOURCEGROUP, LLC
Active
Other names
4SG Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE T STACKS JR. (MANAGING PARTNER)
(404) 936-1294
Entity
Organization
Contact information
Practice address
840 ERNEST W BARRETT PKWY NW, SUITE 572 440552, KENNESAW, GA 30144-6816
(404) 936-1294
Mailing address
840 ERNEST W BARRETT PKWY NW, SUITE 572 440552, KENNESAW, GA 30144-6816
(404) 936-1294
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/22/2013
Last updated
04/22/2013
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