Provider Demographics
NPI:1083969703
Name:GEORGIA MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:GEORGIA MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-695-5500
Mailing Address - Street 1:3316A S COBB DR SE STE 181
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4118
Mailing Address - Country:US
Mailing Address - Phone:800-934-4485
Mailing Address - Fax:
Practice Address - Street 1:3316A S COBB DR SE STE 181
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4118
Practice Address - Country:US
Practice Address - Phone:800-934-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1255638094OtherNPI