Provider Demographics
NPI:1043539281
Name:GENESIS DME, INC.
Entity type:Organization
Organization Name:GENESIS DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREAT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:912-285-5200
Mailing Address - Street 1:2501 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6046
Mailing Address - Country:US
Mailing Address - Phone:912-285-5204
Mailing Address - Fax:912-285-9378
Practice Address - Street 1:983 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0331
Practice Address - Country:US
Practice Address - Phone:912-385-2421
Practice Address - Fax:912-385-2429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS DME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150823AMedicaid
GA003150823AMedicaid
GA000891096AMedicaid