Provider Demographics
NPI:1104007798
Name:DIABETIC MEDIC, LLC
Entity Type:Organization
Organization Name:DIABETIC MEDIC, LLC
Other - Org Name:DIABETIC MEDIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-786-5585
Mailing Address - Street 1:515 IVEY POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3796
Mailing Address - Country:US
Mailing Address - Phone:404-786-5585
Mailing Address - Fax:770-521-1940
Practice Address - Street 1:515 IVEY POINTE WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3796
Practice Address - Country:US
Practice Address - Phone:404-786-5585
Practice Address - Fax:770-521-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-25
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies