Healthcare Provider Details

I. General information

NPI: 1073582003
Provider Name (Legal Business Name): MEDICAL AID SUPPLY HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3547 PEACHTREE INDUSTRIAL BLVD SUITE 4
DULUTH GA
30096-1419
US

IV. Provider business mailing address

3547 PEACHTREE INDUSTRIAL BLVD SUITE 4
DULUTH GA
30096-1419
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-1211
  • Fax: 770-622-1241
Mailing address:
  • Phone: 770-622-1211
  • Fax: 770-622-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number623509993B
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number623509993A
License Number StateGA

VIII. Authorized Official

Name: JEONG HEE WOO
Title or Position: PRESIDENT
Credential:
Phone: 770-622-1211