Crown Healthcare LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

036658 Issued in GA

Legal business name

CROWN HEALTHCARE LLC

Practice address

155 Westridge Pkwy
Suite 106
McDonough, GA 30253-3049

Phone

(404) 289-2500

Fax

(404) 748-4520

NPI assigned

May 25, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Julius Bade Oderinde, MD

Title

Ceo

Phone

(478) 714-6901

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1427377704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 WESTRIDGE PKWY",
            "address_2": "SUITE 106",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302533049",
            "telephone_number": "404-289-2500",
            "fax_number": "404-748-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 WESTRIDGE PKWY",
            "address_2": "SUITE 106",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302533049",
            "telephone_number": "404-289-2500",
            "fax_number": "404-748-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-25",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "ODERINDE",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_middle_name": "BADE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-714-6901",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "036658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1356437040",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in McDonough, GA
• Providers in McDonough, 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 Jan 13, 2011; 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.