MEDICARE: J D S MEDICAL SERVICES & SUPPLIES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies		GA

General Provider Information

NPI Number	:	1548323256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J D S MEDICAL SERVICES & SUPPLIES INC

Provider Business Mailing Address
First Line	:	541 10TH ST NW
Second Line	:	STE 297
City	:	ATLANTA
State	:	GA
Zip	:	30318-5713
Country	:	US
Telephone Number	:	404-761-1445
Fax Number	:	404-768-5870

Provider Business Practice Location Address
First Line	:	2875 LAKEWOOD AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-5801
Country	:	US
Telephone Number	:	404-761-1445
Fax Number	:	404-768-5870

Authorized Official
Title or Position	:	CEO
Name	:	MR. QUINTON JACKSON
Credential	:
Telephone Number	:	404-761-1445

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/08/2008

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