Healthcare Provider Details

I. General information

NPI: 1689253387
Provider Name (Legal Business Name): SKYBOXX STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MEMORIAL DR SE STE 301
ATLANTA GA
30312-2286
US

IV. Provider business mailing address

421 FERN BAY DR SW
ATLANTA GA
30331-8956
US

V. Phone/Fax

Practice location:
  • Phone: 478-955-9203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: DARIUS BOONE
Title or Position: CEO
Credential:
Phone: 424-333-1591