Provider Demographics
NPI:1902803000
Name:MEDICAL EQUIPMENT SPECIALISTS
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT SPECIALISTS
Other - Org Name:MOTUM MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KOLACINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-249-9869
Mailing Address - Street 1:5920 BOULDER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1144
Mailing Address - Country:US
Mailing Address - Phone:470-249-9869
Mailing Address - Fax:678-807-2998
Practice Address - Street 1:106 PILGRIM VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9242
Practice Address - Country:US
Practice Address - Phone:470-253-8067
Practice Address - Fax:678-807-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000804504AMedicaid
GA000804504AMedicaid
GA000804504AMedicaid