MEDICARE: MEDSIDE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	060-R-0068	GA
2	253Z00000X	In Home Supportive Care Agency	060-R-0068	GA
3	251E00000X	Home Health Agency	060-245-H	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306858121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSIDE CORPORATION

Provider Business Mailing Address
First Line	:	1120 HOPE RD # 310
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2957
Country	:	US
Telephone Number	:	404-633-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 HOPE ROAD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350
Country	:	US
Telephone Number	:	404-633-7433
Fax Number	:	888-633-7430

Authorized Official
Title or Position	:	CEO
Name	:	DR. VIKTOR VAYSMAN
Credential	:	MD
Telephone Number	:	404-633-7433

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/19/2020

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Directions to “MEDSIDE CORPORATION ” Practice Location

Language	Start Address	Practice Location

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