Healthcare Provider Details

I. General information

NPI: 1215580253
Provider Name (Legal Business Name): ALZNNER 113 WALKING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 PLEASANT HILL RD STE 106
DULUTH GA
30096-4153
US

IV. Provider business mailing address

2550 PLEASANT HILL RD STE 106
DULUTH GA
30096-4153
US

V. Phone/Fax

Practice location:
  • Phone: 470-733-9177
  • Fax:
Mailing address:
  • Phone: 470-733-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUNAE HYUN LEE
Title or Position: PRESIDENT
Credential: C.PED
Phone: 470-733-9177