Healthcare Provider Details

I. General information

NPI: 1346155058
Provider Name (Legal Business Name): GEORGE MED SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 CAMELLIA LN NE APT 1428
ATLANTA GA
30324-6293
US

IV. Provider business mailing address

7742 SPALDING DR # 386
NORCROSS GA
30092-4207
US

V. Phone/Fax

Practice location:
  • Phone: 943-204-7580
  • Fax:
Mailing address:
  • Phone: 943-204-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARICHARANTEJA MADDURI
Title or Position: OWNER
Credential:
Phone: 943-204-7580