Organization
BABYBOOMERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENATA JOHNSON (AUTHORIZED OFFICIAL)
(678) 779-9061
Entity
Organization
Contact information
Practice address
2053 STANTON RD, EAST POINT, GA 30344-1311
(404) 768-2030
Mailing address
2053 STANTON RD, EAST POINT, GA 30344-1311
(404) 768-2030
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
12/18/2007
Last updated
12/18/2007
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