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General NPI Number Information
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NPI Number | 1730956269
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Entity Type | Organization
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Legal Business Name | THE AJANI BRAND LLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2365 SPRING RD SE STE 215
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City | SMYRNA
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State | GA
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Zip | 30080-2632
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Country | US
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Telephone | 513-400-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 409 WALTON WAY SE
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City | SMYRNA
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State | GA
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Zip | 30082-3854
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Country | US
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Telephone | 513-400-8349
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WENDY STALLWORTH
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Credential |
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Telephone | 513-400-8349
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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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