Organization
MAK MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH MILLSAPS (CEO/PHARMACIST)
(229) 336-7758
Entity
Organization
Contact information
Practice address
159 E BROAD ST, CAMILLA, GA 31730-1842
(229) 336-7758
(229) 336-5615
Mailing address
159 E BROAD ST, CAMILLA, GA 31730-1842
(229) 336-7758
(229) 336-5615
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
PHHH000042
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027448369B
—
GA
Enumeration date
01/25/2012
Last updated
01/25/2012
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