Provider Demographics
NPI:1730482381
Name:MEDICAL AID SUPPLY HOUSE INC
Entity Type:Organization
Organization Name:MEDICAL AID SUPPLY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-622-1211
Mailing Address - Street 1:3547 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1419
Mailing Address - Country:US
Mailing Address - Phone:770-622-1211
Mailing Address - Fax:
Practice Address - Street 1:5659 BUFORD HWY NE
Practice Address - Street 2:STE 112
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1200
Practice Address - Country:US
Practice Address - Phone:770-457-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL AID SUPPLY HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA7335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier