Provider Demographics
NPI:1871887091
Name:SOUTHEASTERN SCIENTIFIC SUPPLY COMPANY LLC
Entity type:Organization
Organization Name:SOUTHEASTERN SCIENTIFIC SUPPLY COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GM
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-913-8768
Mailing Address - Street 1:6883 JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6401
Mailing Address - Country:US
Mailing Address - Phone:770-913-8768
Mailing Address - Fax:770-913-8762
Practice Address - Street 1:6883 JUSTIN DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6401
Practice Address - Country:US
Practice Address - Phone:770-913-8768
Practice Address - Fax:770-913-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20113603522332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies