Provider Demographics
NPI:1942258173
Name:ADA MEDICAL SUPPLY AND SERVICES INC
Entity Type:Organization
Organization Name:ADA MEDICAL SUPPLY AND SERVICES INC
Other - Org Name:ADA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIEDI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-398-0505
Mailing Address - Street 1:6780 ROSWELL RD STE D115
Mailing Address - Street 2:160
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2792
Mailing Address - Country:US
Mailing Address - Phone:678-398-0505
Mailing Address - Fax:678-398-0550
Practice Address - Street 1:6780 ROSWELL RD STE D115
Practice Address - Street 2:160
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2792
Practice Address - Country:US
Practice Address - Phone:678-398-0505
Practice Address - Fax:678-398-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20016201412332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000933193AMedicaid
GA6116480001Medicare NSC