=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831597855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIQUE PLEASANT AND SMOOTH SOLES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2014
-----------------------------------------------------
Last Update Date | 07/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 BUCKEYE RD STE 215
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-224-8172
-----------------------------------------------------
Fax | 678-669-9459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 BUCKEYE RD STE 215
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30341-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-224-8172
-----------------------------------------------------
Fax | 678-669-9459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | WANDA ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-431-8389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------