Organization
BULLOCH HOME MEDICAL INC.
Active
Other names
Georgia Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES ARTHUR FIVEASH JR. (PRESIDENT)
(912) 290-5063
Entity
Organization
Contact information
Practice address
219 B. SOUTH DUVAL STREET, CLAXTON, GA 30417-2031
(912) 290-5063
(912) 290-5066
Mailing address
P.O. BOX 702, CLAXTON, GA 30417-0702
(912) 290-5063
(912) 290-5066
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199141282A
—
GA
Enumeration date
06/08/2006
Last updated
10/18/2011
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