Organization
GRACE-GARANTHE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RANTI HERNANDEZ (AUTHORIZE OFFICIAL)
(770) 441-9992
Entity
Organization
Contact information
Practice address
2400 WISTERIA DR, SUITE F, SNELLVILLE, GA 30078-2689
(770) 441-9992
Mailing address
2400 WISTERIA DR, SUITE F, SNELLVILLE, GA 30078-2689
(770) 441-9992
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
298593
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
298593
HB
GA
Enumeration date
04/28/2016
Last updated
04/28/2016
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