Healthcare Provider Details

I. General information

NPI: 1649103763
Provider Name (Legal Business Name): VERIDIAN MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 PAVILION CT
MCDONOUGH GA
30253-6666
US

IV. Provider business mailing address

824 PAVILION CT
MCDONOUGH GA
30253-6666
US

V. Phone/Fax

Practice location:
  • Phone: 470-507-0619
  • Fax:
Mailing address:
  • Phone: 470-507-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JASMINE T THOMAS
Title or Position: OWNER
Credential:
Phone: 470-507-0619