Healthcare Provider Details

I. General information

NPI: 1073452082
Provider Name (Legal Business Name): BOHO BRAID SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CREST RIDGE DR
EAST POINT GA
30344-5755
US

IV. Provider business mailing address

109 CREST RIDGE DR
EAST POINT GA
30344-5755
US

V. Phone/Fax

Practice location:
  • Phone: 470-753-1902
  • Fax:
Mailing address:
  • Phone: 470-753-1902
  • 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: SABRINA HOWARD
Title or Position: OWNER
Credential:
Phone: 470-753-1902