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General NPI Number Information
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NPI Number | 1316731011
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Entity Type | Organization
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Legal Business Name | INFIGLOW
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 798 LAWRENCEVILLE SUWANEE RD STE 100A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7350
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Country | US
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Telephone | 470-294-1046
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Fax | 302-527-7141
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Provider Business Mailing Address
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Address Line | 798 LAWRENCEVILLE SUWANEE RD STE 100A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7350
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Country | US
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Telephone | 470-294-1046
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Fax | 302-527-7141
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | HYUN JAE CHOI
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Credential |
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Telephone | 404-398-5125
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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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