Provider Demographics
NPI:1245494509
Name:AMY L DANIELLY MEDIQUIP REHABILITATIVE EQUIPMENT & SUPPLIES PLUS
Entity type:Organization
Organization Name:AMY L DANIELLY MEDIQUIP REHABILITATIVE EQUIPMENT & SUPPLIES PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-742-1300
Mailing Address - Street 1:808 PIO NONO AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3536
Mailing Address - Country:US
Mailing Address - Phone:478-742-1300
Mailing Address - Fax:478-742-1302
Practice Address - Street 1:808 PIO NONO AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3536
Practice Address - Country:US
Practice Address - Phone:478-742-1300
Practice Address - Fax:478-742-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6190500001Medicare NSC