Provider Demographics
NPI:1922846484
Name:ATLANTA MEDICAL SOURCING AND SERVICES LLC
Entity type:Organization
Organization Name:ATLANTA MEDICAL SOURCING AND SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMTEIRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-282-8784
Mailing Address - Street 1:12705 CENTURY DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8378
Mailing Address - Country:US
Mailing Address - Phone:404-882-8466
Mailing Address - Fax:404-900-9201
Practice Address - Street 1:12705 CENTURY DR UNIT D
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8378
Practice Address - Country:US
Practice Address - Phone:404-882-8466
Practice Address - Fax:404-900-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies