Healthcare Provider Details

I. General information

NPI: 1396650818
Provider Name (Legal Business Name): LA PEARLS RESTORATION SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SALEM GATE WAY SE
CONYERS GA
30013-1637
US

IV. Provider business mailing address

1233 SALEM GATE WAY SE
CONYERS GA
30013-1637
US

V. Phone/Fax

Practice location:
  • Phone: 678-913-7597
  • Fax:
Mailing address:
  • Phone: 678-913-7597
  • 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: MOCHERIE MURRAY
Title or Position: OWNER
Credential:
Phone: 678-913-7597