Southern Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

957 Issued in GA

Legal business name

SOUTHERN MEDICAL SUPPLY

Practice address

91 Crye Leike Dr
Fort Oglethorpe, GA 30742-4055

Phone

(706) 861-7303

Fax

(706) 861-0201

NPI assigned

Oct 9, 2006

Organization subpart

No

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

Authorized official

Name

Donna Carroll

Title

Office Manager

Phone

(706) 861-7303

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114014347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5513",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307420713",
            "telephone_number": "706-861-7303",
            "fax_number": "706-861-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 CRYE LEIKE DR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424055",
            "telephone_number": "706-861-7303",
            "fax_number": "706-861-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-861-7303"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00434662A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette Stacy Smith, LPN
• Elizabeth N Smith, PHARMD
• Aaron D Solomon, D.P.M.
• Southern Home Care Services, Inc.
• Southern Home Care Services, Inc.
• Brennan Spezia, DPT
• Stephanie Stanton, PHARMD
• Jacqueline Renee Stephenson, PTA
• Kaitlyn Stepp
• Shana L Stokes, LPC

• Durable Medical Equipment & Medical Supplies in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.