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General NPI Number Information
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NPI Number | 1285422741
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Entity Type | Organization
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Legal Business Name | IGNITE RUN COLLECTIVE, LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 5829 CAMPBELLTON RD SW STE 102
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City | ATLANTA
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State | GA
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Zip | 30331-8036
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Country | US
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Telephone | 404-205-5877
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Fax |
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Provider Business Mailing Address
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Address Line | 270 LAWRENCE PL
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City | ATLANTA
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State | GA
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Zip | 30349-1068
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Country | US
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Telephone | 678-523-0452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICKEY ROSS
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Credential |
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Telephone | 678-523-0452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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