Organization
KNOACT MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER MONTREAL FAIRMAN (OWNER)
(607) 879-4202
Entity
Organization
Contact information
Practice address
322 E RAILROAD AVE, CRYSTAL SPRINGS, MS 39059-2848
(601) 879-4202
(769) 233-8683
Mailing address
606 COLONIAL CIR, JACKSON, MS 39211-3206
(601) 879-4202
(769) 233-8683
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
800739368
MS
Other
Enumeration date
12/27/2017
Last updated
12/27/2017
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