Provider Demographics
NPI:1659990810
Name:SDS MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:SDS MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:SEABORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-664-3054
Mailing Address - Street 1:2375 WALL ST SE RM 50
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6702
Mailing Address - Country:US
Mailing Address - Phone:770-285-4104
Mailing Address - Fax:770-285-4152
Practice Address - Street 1:2375 WALL ST SE STE 240 RM 50
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6702
Practice Address - Country:US
Practice Address - Phone:770-285-4104
Practice Address - Fax:770-285-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies