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General NPI Number Information
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NPI Number | 1548860810
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Entity Type | Organization
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Legal Business Name | CROWNS OF LOVE INC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 707 PARK AVE NE APT 1382
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City | ATLANTA
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State | GA
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Zip | 30326-3410
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Country | US
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Telephone | 404-319-3544
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Fax |
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Provider Business Mailing Address
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Address Line | 707 PARK AVE NE APT 1382
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City | ATLANTA
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State | GA
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Zip | 30326-3410
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Country | US
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Telephone | 404-319-3544
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | LATRYCE GOLLIDAY
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Credential |
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Telephone | 404-319-3544
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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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