Healthcare Provider Details

I. General information

NPI: 1346156833
Provider Name (Legal Business Name): BLUE TOPAZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 DAHLGREN LN SE
ATLANTA GA
30316-1619
US

IV. Provider business mailing address

244 SPENCE AVE SE
ATLANTA GA
30317-3321
US

V. Phone/Fax

Practice location:
  • Phone: 470-301-1053
  • Fax:
Mailing address:
  • Phone: 470-301-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MELISSA WILLINGHAM
Title or Position: CEO
Credential: MC
Phone: 470-301-1053