Organization
FORWARD BOUND MOBILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNNY LARRY GRIMES (OWNER)
(404) 376-7479
Entity
Organization
Contact information
Practice address
745 ATLANTA RD, SUITE 109, CUMMING, GA 30040-2745
(678) 455-9220
(678) 455-9250
Mailing address
745 ATLANTA RD, SUITE 109, CUMMING, GA 30040-2745
(678) 455-9220
(678) 455-9250
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213601448A
—
GA
Enumeration date
06/04/2008
Last updated
02/08/2012
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