Organization
AMERICAN MEDICAL SYSTEMS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NORRIS W WALLACE III (PRESIDENT)
(478) 741-3697
Entity
Organization
Contact information
Practice address
1745 CLINTON RD, MACON, GA 31211-1721
(478) 741-3697
(478) 750-1474
Mailing address
PO BOX 2827, MACON, GA 31203
(478) 741-3697
(478) 750-1474
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000224892A
—
GA
Enumeration date
11/17/2006
Last updated
03/17/2017
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