Organization
GOLDEN AGE INC
Active
Other names
DME Supplier
Organization subpart
No
Provider details
NPI number
Authorized official
TABATHA WATKINS (ADMINISTRATOR)
(662) 453-6323
Entity
Organization
Contact information
Practice address
2901 HIGHWAY 82 E, GREENWOOD, MS 38930-6072
(662) 453-6323
(662) 455-9686
Mailing address
2901 HWY 82 E, GREENWOOD, MS 38930-6072
(662) 453-6323
(662) 455-9686
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
46
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0440264
—
MS
Enumeration date
09/21/2005
Last updated
01/20/2022
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