Provider Demographics
NPI:1528134145
Name:CAREFIRST MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:CAREFIRST MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:CHIZOBA
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-996-7489
Mailing Address - Street 1:6030 HWY 85
Mailing Address - Street 2:SUITE 224
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-996-7489
Mailing Address - Fax:770-996-7582
Practice Address - Street 1:6030 HWY 85
Practice Address - Street 2:SUITE 224
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-996-7489
Practice Address - Fax:770-996-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5482330001Medicare ID - Type Unspecified