Provider Demographics
NPI:1578393914
Name:AMENITY MEDICAL LLC
Entity type:Organization
Organization Name:AMENITY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASSATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-485-5491
Mailing Address - Street 1:780 VETERANS MEMORIAL HWY SW STE 112
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3356
Mailing Address - Country:US
Mailing Address - Phone:678-485-5491
Mailing Address - Fax:
Practice Address - Street 1:780 VETERANS MEMORIAL HWY SW STE 112
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3356
Practice Address - Country:US
Practice Address - Phone:678-485-5491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies