Provider Demographics
NPI:1528850229
Name:PRIME MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:PRIME MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-504-4005
Mailing Address - Street 1:120 N MCDONOUGH ST STE 500
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:770-504-4005
Mailing Address - Fax:470-575-6312
Practice Address - Street 1:120 N MCDONOUGH ST STE 500
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3675
Practice Address - Country:US
Practice Address - Phone:770-504-4005
Practice Address - Fax:470-575-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies