| Organization Name: | QUEEN CITY HOME MEDICAL, LLC |
| NPI Number: | 1710923693 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAMELIA GALE WHITE (OWNER) |
| Mailing Address: | 2109 S Main St Suite A Blakely |
| State: | GA US |
| Postal Code: | 398232277 |
| Phone Number: | 2297238009 |
| Fax Number: | 2297238005 |
| NPI Enumeration Date: | 06/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 20015314787 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |