Kingdom Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

KINGDOM MEDICAL SUPPLY LLC

Practice address

1020 Park Drive
Suite B
Greensboro, GA 30642

Phone

(706) 453-1123

Fax

(706) 453-1124

NPI assigned

Jun 18, 2008

Last updated

Dec 31, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Teresa Dianne Lawrence

Title

Ceo

Phone

(706) 453-1123

Specialties & licenses 2

Addresses

Other names 1

• KINGDOM MEDICAL SUPPLY LLC Former legal business name

Locations

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1144481516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 PARK DRIVE",
            "address_2": "SUITE B",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "30647",
            "telephone_number": "706-453-1123",
            "fax_number": "706-453-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 PARK DRIVE",
            "address_2": "SUITE B",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "30642",
            "telephone_number": "706-453-1123",
            "fax_number": "706-453-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "DIANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-453-1123",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KINGDOM MEDICAL SUPPLY LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Donna Amanda Kauffman, NP
• Emily Keeton, DMD
• Donald Matson Keiser III, RPH
• Michael Kelly, M.D.
• Kevin Adrian King, DPT
• Arun Kumar, M.D
• Karissa Joy Lacy, DC
• Lake Medical Center
• Lake Oconee Assisted Living Home
• Lake Oconee Assisted Living, LLC (Kingdom Care Service Center)

• Durable Medical Equipment & Medical Supplies in Greensboro, GA
• Providers in Greensboro, 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 Dec 31, 2015; 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.