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General NPI Number Information
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NPI Number | 1306858121
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Entity Type | Organization
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Legal Business Name | MEDSIDE CORPORATION
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 1120 HOPE ROAD
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City | SANDY SPRINGS
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State | GA
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Zip | 30350
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Country | US
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Telephone | 404-633-7433
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Fax | 888-633-7430
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Provider Business Mailing Address
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Address Line | 1120 HOPE RD # 310
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-2957
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Country | US
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Telephone | 404-633-7433
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VIKTOR VAYSMAN
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Credential | MD
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Telephone | 404-633-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060-R-0068
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 060-R-0068
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060-245-H
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License Number State | GA
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