Healthcare Provider Details

I. General information

NPI: 1306460662
Provider Name (Legal Business Name): UNIQUE CREATIONZ RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DALLAS HWY SW STE 202-1082
MARIETTA GA
30064-2567
US

IV. Provider business mailing address

2500 DALLAS HWY SW STE 202-1082
MARIETTA GA
30064-2567
US

V. Phone/Fax

Practice location:
  • Phone: 706-587-2370
  • Fax: 770-766-8337
Mailing address:
  • Phone: 706-587-2370
  • Fax: 972-645-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARQUISHA GENERAL
Title or Position: OWNER
Credential:
Phone: 706-587-2370