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General NPI Number Information
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NPI Number | 1902673205
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Entity Type | Organization
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Legal Business Name | ELITE GLAM SOCIETY
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4621 STEWART REILLY DR
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City | ACWORTH
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State | GA
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Zip | 30101-2695
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Country | US
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Telephone | 678-709-3505
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 NORTHSIDE DR NW STE A7
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City | ATLANTA
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State | GA
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Zip | 30318-2695
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Country | US
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Telephone | 678-709-3505
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER ASHLEY TAYLOR
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Credential |
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Telephone | 678-709-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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