Organization
BLUE EAGLE DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WILSON RPH (SECRETARY)
(478) 237-3609
Entity
Organization
Contact information
Practice address
1110 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-7271
(770) 474-0842
(478) 237-2217
Mailing address
PO BOX 1128, SWAINSBORO, GA 30401-1128
(478) 237-3609
(478) 237-3609
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/03/2006
Last updated
08/22/2020
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