Provider Demographics
NPI:1114052396
Name:MED SOUTH SURGICAL, INC.
Entity Type:Organization
Organization Name:MED SOUTH SURGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-292-9747
Mailing Address - Street 1:PO BOX 28126
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30358-0126
Mailing Address - Country:US
Mailing Address - Phone:770-292-9747
Mailing Address - Fax:770-292-9754
Practice Address - Street 1:6535 SHILOH RD
Practice Address - Street 2:SUITE C600
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1608
Practice Address - Country:US
Practice Address - Phone:770-292-9747
Practice Address - Fax:770-292-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1008660001Medicare NSC