Organization
EVERGREEN MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIJU THOMAS (CEO)
(267) 368-9582
Entity
Organization
Contact information
Practice address
2330 SCENIC HWY S STE 303, SNELLVILLE, GA 30078-3115
(678) 502-1440
(678) 502-1441
Mailing address
2330 SCENIC HWY S STE 303, SNELLVILLE, GA 30078-3115
(678) 502-1440
(678) 502-1441
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
08/14/2025
Last updated
08/14/2025
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