Organization
MAXICARE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EFIONG EYO MBABA REGISTERED NURSE (OWNER)
(770) 907-0194
Entity
Organization
Contact information
Practice address
804 COMMERCE BLVD, SUITE A-32, RIVERDALE, GA 30296-7198
(770) 907-0194
(770) 907-0195
Mailing address
804 COMMERCE BLVD, SUITE A-32, RIVERDALE, GA 30296-7198
(770) 907-0194
(770) 907-0195
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
06-19916
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379763323A
—
GA
Enumeration date
04/16/2008
Last updated
08/25/2008
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