NPIMap

Organization Active NPI

Medlife Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucker, GA
National Provider Identifier
1164691598
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
20020660338 Issued in GA
Legal business name
MEDLIFE MEDICAL SUPPLY LLC
Practice address
2191 Northlake Pkwy
Suite-J BLDG #11
Tucker, GA 30084-4166
Phone
(770) 908-5666
Fax
(770) 908-5675
NPI assigned
Feb 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Kenneth B SmithNPI 1851572051
Title
Owner General Manager
Phone
(770) 908-5666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 20020660338 GA Primary

Addresses

Primary practice location

2191 Northlake Pkwy
Suite-J BLDG #11
Tucker, GA 30084-4166

Mailing address

2191 Northlake Pkwy
Suite-J BLDG #11
Tucker, GA 30084-4166
Phone (770) 908-5666

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1164691598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2191 NORTHLAKE PKWY",
            "address_2": "SUITE-J BLDG #11",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844166",
            "telephone_number": "770-908-5666",
            "fax_number": "770-908-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2191 NORTHLAKE PKWY",
            "address_2": "SUITE-J BLDG #11",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844166",
            "telephone_number": "770-908-5666",
            "fax_number": "770-908-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLIFE MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-29",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER GENERAL MANAGER",
        "authorized_official_telephone_number": "770-908-5666"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "20020660338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.