Provider Demographics
NPI:1043287626
Name:PREMIER MEDICAL SERVICES
Entity type:Organization
Organization Name:PREMIER MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-767-6400
Mailing Address - Street 1:327 DAHLONEGA ST STE A603
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2488
Mailing Address - Country:US
Mailing Address - Phone:770-781-4138
Mailing Address - Fax:770-781-2588
Practice Address - Street 1:327 DAHLONEGA ST STE A603
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2488
Practice Address - Country:US
Practice Address - Phone:770-781-4138
Practice Address - Fax:770-781-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA519893850AMedicaid
GA356770OtherWELLCARE
GA459823570AMedicaid
GA6690445OtherCIGNA
GA5931689OtherAETNA
GA82480OtherNORTHWOODS
GA52614526OtherBLUE CROSS BLUE SHIELD
GA6690445OtherCIGNA
GA=========OtherPMSI
GA=========OtherHOMELINK
GA519893850AMedicaid
GA52614526OtherBLUE CROSS BLUE SHIELD
GA82480OtherNORTHWOODS
GA459823570AMedicaid
GA=========OtherSOUTHCARE/COVENTRY