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General NPI Number Information
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NPI Number | 1376724088
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Entity Type | Organization
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Legal Business Name | MARY LOU'S GARDEN, INC.
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 10 S BARNETT SHOALS RD SUITE C.
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City | WATKINSVILLE
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State | GA
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Zip | 30677-2500
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Country | US
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Telephone | 706-310-7175
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Fax | 706-310-7176
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Provider Business Mailing Address
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Address Line | PO BOX 1723
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City | WATKINSVILLE
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State | GA
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Zip | 30677-0034
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Country | US
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Telephone | 706-310-7175
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Fax | 706-310-7176
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Authorized Official
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Title or Position | OWNER
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Name | JAIMEE M DEAN
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Credential | RN
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Telephone | 706-310-7175
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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 | INV-8-06-988
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License Number State | GA
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Taxonomy #2
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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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