Healthcare Provider Details

I. General information

NPI: 1699246942
Provider Name (Legal Business Name): TKHAIR247 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GALLERIA PKWY SE, SUITE 1D2
ATLANTA GA
30339-3008
US

IV. Provider business mailing address

2146 ROSWELL RD 108-1110
MARIETTA GA
30062
US

V. Phone/Fax

Practice location:
  • Phone: 678-760-0484
  • Fax:
Mailing address:
  • Phone: 678-760-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: TK COX
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 678-760-0484