Mercy Medical Supply LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

MERCY MEDICAL SUPPLY LLC

Doing business as

Mercy Medical Supply, LLC

Practice address

3584 Highway 138 SE
Stockbridge, GA 30281

Phone

(770) 506-9944

Fax

(770) 506-9921

NPI assigned

Sep 10, 2008

Organization subpart

Yes

Parent organization

MERCY MEDICAL SUPPLY, LLCAs reported in NPPES

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

Authorized official

Name

Ms. Jacqueline Kay Johnson

Title

President/Owner

Phone

(770) 506-9944

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mercy Medical Supply, LLC Doing business as

Part of

Mercy Medical Supply LLC

Locations

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535673600000",
    "number": "1477702801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3584 HIGHWAY 138 SE",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814171",
            "telephone_number": "770-506-9944",
            "fax_number": "770-506-9921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3584 HIGHWAY 138 SE",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-506-9944",
            "fax_number": "770-506-9921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL SUPPLY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY MEDICAL SUPPLY,  LLC",
        "enumeration_date": "2008-09-10",
        "last_updated": "2018-08-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "770-506-9944",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076482217A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Medical Supply, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Medical Supply, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Customized Equipment (DME) in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Customized Equipment (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.