Organization
SOUTHERN HOME MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RAYMOND CONNELL (OWNER)
(229) 392-0194
Entity
Organization
Contact information
Practice address
72 KENT RD, SUITE 6, TIFTON, GA 31794-1694
(229) 396-5501
(229) 396-5503
Mailing address
72 KENT RD, SUITE 6, TIFTON, GA 31794-1694
(229) 396-5501
(229) 396-5503
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
GA
Other
Enumeration date
02/06/2012
Last updated
08/17/2012
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