Healthcare Provider Details

I. General information

NPI: 1730016379
Provider Name (Legal Business Name): PURE CROWN COUTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PEACHTREE INDUSTRIAL BLVD STE 105
DULUTH GA
30097-8627
US

IV. Provider business mailing address

2730 PEACHTREE INDUSTRIAL BLVD SUITE 105
DULUTH GA
30097-8626
US

V. Phone/Fax

Practice location:
  • Phone: 213-500-0938
  • Fax:
Mailing address:
  • Phone: 213-500-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. KENYA S CAMPBELL
Title or Position: OWNER
Credential:
Phone: 213-500-0938