Healthcare Provider Details

I. General information

NPI: 1902715444
Provider Name (Legal Business Name): PURITY MEDICAL WIGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 DRIGGS DR NW
ATLANTA GA
30318-1220
US

IV. Provider business mailing address

1582 DRIGGS DR NW
ATLANTA GA
30318-1220
US

V. Phone/Fax

Practice location:
  • Phone: 470-637-1109
  • Fax:
Mailing address:
  • Phone: 470-637-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL MCNEAL
Title or Position: OWNER
Credential:
Phone: 470-637-1109