Xcalibur

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

20170210145 Issued in GA

Legal business name

XCALIBUR

Practice address

1071 Hanover Dr
Madison, GA 30650

Phone

(678) 500-9542

Fax

(678) 500-9543

NPI assigned

Aug 28, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marty Ray Frierson

Title

Owner

Phone

(678) 520-3464

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1023366739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1071 HANOVER DR",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "30650",
            "telephone_number": "678-500-9542",
            "fax_number": "678-500-9543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 HANOVER DR",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "30650",
            "telephone_number": "678-500-9542",
            "fax_number": "678-500-9543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XCALIBUR",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-28",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "FRIERSON",
        "authorized_official_first_name": "MARTY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-520-3464"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "GA",
            "license": "20170210145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shontell Monik White, MASTER'S LEVEL
• Kyle Henley Wilkinson, CPA
• Monica La'Shea Williams, APRN, MSN, FNP-C
• Whitney Nicole Williams, CPNP
• O. Adrian Woodruff Jr., DMD, PC
• Barbara I Yarn, MD
• Zant Extended Care, Inc.
• Walter Daniel Zant Jr., MD

• Customized Equipment (DME) in Madison, GA
• Providers in Madison, GA by specialty
• Customized Equipment (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.