Organization
LIBERTY MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SUE IVESTER II (OWNER)
(478) 929-9410
Entity
Organization
Contact information
Practice address
1220 RUSSELL PARKWAY, SUITE 2, WARNER ROBINS, GA 31088
(478) 929-9410
Mailing address
1220 RUSSELL PARKWAY, SUITE 2, WARNER ROBINS, GA 31088
(478) 929-9410
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00940497A
—
GA
01
—
125205000
U.S. DEPARTMENT OF LABOR
GA
Enumeration date
12/21/2006
Last updated
07/21/2022
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