Queen City Home Medical, LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

20015314787 Issued in GA

Legal business name

QUEEN CITY HOME MEDICAL, LLC

Practice address

11510 Columbia St
Suite J
Blakely, GA 39823-2788

Phone

(229) 723-8009

Fax

(229) 723-8005

NPI assigned

Jun 21, 2006

Last updated

Apr 14, 2017By 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

Pamelia Gale White

Title

Owner

Phone

(229) 723-8009

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1710923693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11510 COLUMBIA ST",
            "address_2": "SUITE J",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232788",
            "telephone_number": "229-723-8009",
            "fax_number": "229-723-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11510 COLUMBIA ST",
            "address_2": "SUITE J",
            "city": "BLAKELY",
            "state": "GA",
            "postal_code": "398232788",
            "telephone_number": "229-723-8009",
            "fax_number": "229-723-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN CITY HOME MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "PAMELIA",
        "authorized_official_middle_name": "GALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-723-8009"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "GA",
            "license": "20015314787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisa Spann Price, LPC
• Lindsay Austin Prickett, OT
• Primary Care of Southwest Georgia, Inc (Blakely Primary Care Pharmacy)
• Primary Care of Southwest Georgia, Inc (Primary Care of Southwest Georgia- Early County Elementary School)
• Primary Care of Southwest Georgia, Inc.
• Tina G. Rackley, SLP
• Arthur Redding, RPH
• Daneisha Latrell Rogers, DNP, FNP-C
• Jennifer Ross, PA-C
• Haley Rykard, LPC

• Oxygen Equipment & Supplies (DME) in Blakely, GA
• Providers in Blakely, GA by specialty
• Oxygen Equipment & Supplies (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2017; 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.