Provider Demographics
NPI:1972142891
Name:WORLDWIDE MEDICAL DISTRIBUTOR, LLC
Entity type:Organization
Organization Name:WORLDWIDE MEDICAL DISTRIBUTOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-389-9116
Mailing Address - Street 1:3780 OLD NORCROSS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1762
Mailing Address - Country:US
Mailing Address - Phone:770-389-9116
Mailing Address - Fax:770-506-4580
Practice Address - Street 1:3780 OLD NORCROSS RD STE 103
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1762
Practice Address - Country:US
Practice Address - Phone:770-389-9116
Practice Address - Fax:770-506-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA243038113BMedicaid