Organization
THE OXYGEN STORE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EARL WALTON DUNLAP (PRESIDENT)
(706) 290-1330
Entity
Organization
Contact information
Practice address
115 JOHN MADDOX DR NW, ROME, GA 30165-1419
(706) 290-1330
(706) 290-1332
Mailing address
115 JOHN MADDOX DR NW, ROME, GA 30165-1419
(706) 290-1330
(706) 290-1332
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00953345A
—
GA
Enumeration date
10/11/2006
Last updated
08/22/2020
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