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General NPI Number Information
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NPI Number | 1518659218
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Entity Type | Organization
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Legal Business Name | J LIGHT COLLECTION LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 2383 AKERS MILL RD SE
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City | ATLANTA
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State | GA
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Zip | 30339-2503
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Country | US
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Telephone | 470-694-3064
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Fax |
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Provider Business Mailing Address
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Address Line | 6595 ROSWELL RD STE G-5546
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City | ATLANTA
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State | GA
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Zip | 30328-3152
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Country | US
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Telephone | 470-694-3064
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LAKIA SCOTT
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Credential |
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Telephone | 215-715-3250
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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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