Provider Demographics
NPI:1306858121
Name:MEDSIDE CORPORATION
Entity Type:Organization
Organization Name:MEDSIDE CORPORATION
Other - Org Name:MEDSIDE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-633-7433
Mailing Address - Street 1:1120 HOPE RD # 310
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2957
Mailing Address - Country:US
Mailing Address - Phone:404-633-7433
Mailing Address - Fax:
Practice Address - Street 1:1120 HOPE ROAD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:404-633-7433
Practice Address - Fax:888-633-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-245-H251E00000X
GA060-R-0068251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003231615AMedicaid
GA00869943DMedicaid
GA00869943BMedicaid
GA00869943AMedicaid
GA00849527AMedicaid
GA00869943CMedicaid