Healthcare Provider Details

I. General information

NPI: 1982528790
Provider Name (Legal Business Name): CREATING IMAGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 HIGHWAY 138 SE
CONYERS GA
30013-1297
US

IV. Provider business mailing address

30 HOMESTEAD WAY
COVINGTON GA
30014-7608
US

V. Phone/Fax

Practice location:
  • Phone: 770-309-8446
  • Fax:
Mailing address:
  • Phone: 770-309-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TREVAIL RINITE MATTOS
Title or Position: OWNER
Credential:
Phone: 770-309-8446