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General NPI Number Information
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NPI Number | 1568808491
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Entity Type | Organization
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Legal Business Name | INTIMATES PLUS LLC
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Dates
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Enumeration Date | 05/19/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 5900 SUGARLOAF PKWY SUITE 116
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7857
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Country | US
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Telephone | 770-906-7759
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Fax |
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Provider Business Mailing Address
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Address Line | 4865 MICHAEL JAY ST
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City | SNELLVILLE
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State | GA
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Zip | 30039-7644
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Country | US
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Telephone | 770-906-7759
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISSANN JONES
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Credential |
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Telephone | 770-906-7759
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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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