Provider Demographics
NPI:1033902127
Name:MR L MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:MR L MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAFAYETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-626-1633
Mailing Address - Street 1:122 N MCDONOUGH ST # 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3675
Mailing Address - Country:US
Mailing Address - Phone:404-448-4813
Mailing Address - Fax:
Practice Address - Street 1:194 JONESBORO RD STE B4
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4817
Practice Address - Country:US
Practice Address - Phone:678-626-1633
Practice Address - Fax:470-300-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies