Organization
MEDICAL SUPPLIES ON MAIN STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OLIVIA H. BANKS (OWNER)
(770) 358-0909
Entity
Organization
Contact information
Practice address
204 MAIN ST, BARNESVILLE, GA 30204-1468
(770) 358-0909
(770) 358-0095
Mailing address
204 MAIN ST, BARNESVILLE, GA 30204-1468
(770) 358-0909
(770) 358-0095
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
973262504A
—
GA
Enumeration date
07/05/2006
Last updated
07/23/2008
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