Organization
DEVOTION MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EFE OWEN (MANAGER)
(678) 817-4418
Entity
Organization
Contact information
Practice address
101 KENWOOD RD STE 26, FAYETTEVILLE, GA 30214-3418
(678) 817-4418
(678) 817-4419
Mailing address
101 KENWOOD RD STE 26, FAYETTEVILLE, GA 30214-3418
(678) 817-4418
(678) 817-4419
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
305849627
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101190
FAYETTE COUNTY OCCUPATIONAL TAX CERTIFICATE
GA
01
—
305849627
STATE TAX IDENTIFICATION
GA
Enumeration date
06/22/2009
Last updated
01/31/2019
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