Provider Demographics
NPI:1336918085
Name:ADT MEDICALS LLC
Entity Type:Organization
Organization Name:ADT MEDICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-844-1970
Mailing Address - Street 1:154 HANK DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5838
Mailing Address - Country:US
Mailing Address - Phone:470-844-1970
Mailing Address - Fax:
Practice Address - Street 1:154 HANK DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5838
Practice Address - Country:US
Practice Address - Phone:470-844-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty