Provider Demographics
NPI:1750408456
Name:FIRST MEDICAL SUPPLIERS INC
Entity type:Organization
Organization Name:FIRST MEDICAL SUPPLIERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MCCLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-696-0091
Mailing Address - Street 1:75 MENDEL DR SW STE H
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-2023
Mailing Address - Country:US
Mailing Address - Phone:404-696-0091
Mailing Address - Fax:404-696-0092
Practice Address - Street 1:75 MENDEL DR SW STE H
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30336-2023
Practice Address - Country:US
Practice Address - Phone:404-696-0091
Practice Address - Fax:404-696-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00638976AMedicaid
GA00638976AMedicaid