Mak Medical, LLC

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

PHHH000042 Issued in GA

Legal business name

MAK MEDICAL, LLC

Practice address

159 E Broad St
Camilla, GA 31730-1842

Phone

(229) 336-7758

Fax

(229) 336-5615

NPI assigned

Jan 25, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Elizabeth Millsaps

Title

Ceo/Pharmacist

Phone

(229) 336-7758

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1912278755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 E BROAD ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301842",
            "telephone_number": "229-336-7758",
            "fax_number": "229-336-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 E BROAD ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301842",
            "telephone_number": "229-336-7758",
            "fax_number": "229-336-5615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAK MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "MILLSAPS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO/PHARMACIST",
        "authorized_official_telephone_number": "229-336-7758",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "GA",
            "license": "PHHH000042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027448369B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barry T Leath, CRNA
• Katy L. Lewis, MS OTR/L
• Christine M Lockhart, CNP
• Staci A Mackey
• Mak Medical LLC
• Mak Pharmacy LLC
• Ashley Nicole Maxwell, OTR/L
• Carly McCook, SLP
• Gregory McCullough
• Shaytoria Janea McDuffie, CNA

• Parenteral & Enteral Nutrition Supplies (DME) in Camilla, GA
• Providers in Camilla, GA by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; 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.