Healthcare Provider Details

I. General information

NPI: 1598660771
Provider Name (Legal Business Name): MI AMOUR COLLECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-7343
US

IV. Provider business mailing address

966 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-7343
US

V. Phone/Fax

Practice location:
  • Phone: 678-782-5082
  • Fax:
Mailing address:
  • Phone: 678-782-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARM VEGA
Title or Position: CRANIAL PROTHESIS SPECIALIST
Credential:
Phone: 678-770-4465