Donalsonville Tri-State Home Medical LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DONALSONVILLE TRI-STATE HOME MEDICAL LLC

Practice address

801 N Wiley Ave
Donalsonville, GA 39845-1121

Phone

(229) 524-8911

Fax

(229) 524-2300

NPI assigned

Dec 14, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Jack H Mills Sr., RPH9642 REGISTERED P

Title

Owner

Phone

(229) 524-8911

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1255600698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "address_2": "801 N WILEY AVE",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "398450157",
            "telephone_number": "229-524-8911",
            "fax_number": "229-524-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N WILEY AVE",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "398451121",
            "telephone_number": "229-524-8911",
            "fax_number": "229-524-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONALSONVILLE TRI-STATE HOME MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-524-8911",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "RPH9642 REGISTERED P"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000922237AB",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Future Vision of Southwest Georgia

• All providers in Donalsonville, GA
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; 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.