Provider Demographics
NPI:1366753196
Name:ADVANCED DIABETIC SOLUTIONS
Entity type:Organization
Organization Name:ADVANCED DIABETIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SANTULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-1190
Mailing Address - Street 1:4850 SUGARLOAF PKWY
Mailing Address - Street 2:209-152
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2859
Mailing Address - Country:US
Mailing Address - Phone:770-339-1190
Mailing Address - Fax:770-339-1192
Practice Address - Street 1:94-050 FARRINGTON HWY
Practice Address - Street 2:#B1-3
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1841
Practice Address - Country:US
Practice Address - Phone:808-671-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies