Provider Demographics
NPI:1982607222
Name:MEDICAL AID SUPPLY HOUSE INC
Entity type:Organization
Organization Name:MEDICAL AID SUPPLY HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-622-1211
Mailing Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 980
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6506
Mailing Address - Country:US
Mailing Address - Phone:770-622-1211
Mailing Address - Fax:
Practice Address - Street 1:3455 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 980
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6506
Practice Address - Country:US
Practice Address - Phone:770-622-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
GAC21507335E00000X
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5069580002Medicare NSC