Provider Demographics
NPI:1205103744
Name:ADVANCED DIABETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:ADVANCED DIABETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SANTULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-1190
Mailing Address - Street 1:225 NOAH DRIVE
Mailing Address - Street 2:SUITE 383
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3955
Mailing Address - Country:US
Mailing Address - Phone:770-339-1109
Mailing Address - Fax:770-339-1192
Practice Address - Street 1:225 NOAH DR
Practice Address - Street 2:SUITE 383
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3952
Practice Address - Country:US
Practice Address - Phone:770-339-1190
Practice Address - Fax:770-339-1192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED DIABETIC SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-29
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies