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General NPI Number Information
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NPI Number | 1770659385
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Entity Type | Organization
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Legal Business Name | CROSS CREEK ENTERPRISE, INC.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 1778 JONESBORO RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-5900
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Country | US
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Telephone | 770-914-9323
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Fax | 770-914-9324
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Provider Business Mailing Address
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Address Line | 1778 JONESBORO RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-5900
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Country | US
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Telephone | 770-914-9323
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Fax | 770-914-9324
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LINDA S. SANDERS
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Credential | C.PED
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Telephone | 770-914-9323
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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 | 2286352-LB
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License Number State | GA
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