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General NPI Number Information
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NPI Number | 1891421368
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Entity Type | Organization
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Legal Business Name | LL VIRTUAL SERVICES
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 4630 HIGH GATE LN
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City | LITHONIA
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State | GA
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Zip | 30038-3621
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Country | US
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Telephone | 404-590-1074
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Fax | 833-216-6562
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Provider Business Mailing Address
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Address Line | 4630 HIGH GATE LN
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City | LITHONIA
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State | GA
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Zip | 30038-3621
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Country | US
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Telephone | 404-590-1074
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Fax | 833-216-6562
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LATRICE LITTLES
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Credential |
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Telephone | 404-838-1417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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