Organization
SOURCE MEDICAL SUPPLIES
Active
Organization
SOURCE MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SMITH (OFFICER)
(678) 755-2554
Entity
Organization
Contact information
Practice address
1572 HIGHWAY 85 N STE 316, FAYETTEVILLE, GA 30214-7727
(678) 755-2554
Mailing address
100 NORTHTOWNE CV, STOCKBRIDGE, GA 30281-1097
(678) 755-2554
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/26/2023
Last updated
08/31/2023
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