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General NPI Number Information
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NPI Number | 1073469326
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Entity Type | Organization
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Legal Business Name | PROCROWN PROSTHETICS
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 3405 SANDALWOOD DR
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City | ATLANTA
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State | GA
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Zip | 30350-2333
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Country | US
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Telephone | 484-844-9776
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 SHALLOWFORD RD STE 166
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City | ROSWELL
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State | GA
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Zip | 30075-3180
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Country | US
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Telephone | 484-844-9776
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JERE JONES
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Credential |
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Telephone | 484-844-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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