Healthcare Provider Details

I. General information

NPI: 1326917923
Provider Name (Legal Business Name): DOMAINFLIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10302 ASHFORD GABLES DR
DUNWOODY GA
30338-7875
US

IV. Provider business mailing address

10302 ASHFORD GABLES DR
DUNWOODY GA
30338-7875
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-4519
  • Fax:
Mailing address:
  • Phone: 404-446-4519
  • 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: MISS ASHLEY ANGEL
Title or Position: OWNER
Credential: SR
Phone: 404-446-4519