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General NPI Number Information
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NPI Number | 1669385100
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Entity Type | Organization
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Legal Business Name | ELITE CROWNING GLORY LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 413 N 5TH ST
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City | JESUP
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State | GA
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Zip | 31545-1024
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Country | US
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Telephone | 912-630-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 E OGLETHORPE HWY # 1002
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City | HINESVILLE
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State | GA
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Zip | 31313-1219
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Country | US
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Telephone | 912-630-7678
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. ANGELA DARDEN-RIVERS
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Credential |
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Telephone | 912-630-7678
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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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