Healthcare Provider Details

I. General information

NPI: 1518851823
Provider Name (Legal Business Name): R & G LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST N APT 47
COLUMBUS MS
39701-3455
US

IV. Provider business mailing address

1125 6TH ST N APT 47
COLUMBUS MS
39701-3455
US

V. Phone/Fax

Practice location:
  • Phone: 662-352-9394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAKENDRA MONTGOMERY
Title or Position: OWNER
Credential:
Phone: 662-352-9394