Provider Demographics
NPI:1043523772
Name:ANDERSON, ZACHARY AUGUSTUS
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:AUGUSTUS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 WELLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8963
Mailing Address - Country:US
Mailing Address - Phone:770-689-7160
Mailing Address - Fax:
Practice Address - Street 1:2333 WELLINGTON CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8963
Practice Address - Country:US
Practice Address - Phone:770-689-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies