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General NPI Number Information
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NPI Number | 1265152383
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Entity Type | Organization
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Legal Business Name | BREATHE BEAUTY LA
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 4140 MOORE RD STE B114
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City | SUWANEE
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State | GA
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Zip | 30024-7157
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Country | US
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Telephone | 678-866-1468
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Fax |
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Provider Business Mailing Address
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Address Line | 4140 MOORE RD STE B114
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City | SUWANEE
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State | GA
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Zip | 30024-7157
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Country | US
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Telephone | 678-866-1468
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. OLUWAFUNMILAYO MAKINDE
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Credential |
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Telephone | 678-866-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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