Provider Demographics
NPI:1548323256
Name:J D S MEDICAL SERVICES & SUPPLIES INC
Entity type:Organization
Organization Name:J D S MEDICAL SERVICES & SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-761-1445
Mailing Address - Street 1:541 10TH ST NW
Mailing Address - Street 2:STE 297
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5713
Mailing Address - Country:US
Mailing Address - Phone:404-761-1445
Mailing Address - Fax:404-768-5870
Practice Address - Street 1:2875 LAKEWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5801
Practice Address - Country:US
Practice Address - Phone:404-761-1445
Practice Address - Fax:404-768-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4653170001Medicare NSC