| Organization Name: | PEACH STATE MEDICAL SUPPLIES, LLC |
| NPI Number: | 1669577185 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW ROBERT GOLDE (VICE-PRESIDENT) |
| Mailing Address: | 11815 Northfall Ln Suite 1003 Alpharetta |
| State: | GA US |
| Postal Code: | 300047973 |
| Phone Number: | 6784460894 |
| Fax Number: | 7703469394 |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 03/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |