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General NPI Number Information
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NPI Number | 1982297339
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Entity Type | Organization
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Legal Business Name | LOVE LACE LUXURY WIGS BY MONET
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 2090 LAWRENCEVILLE- SUWANEE ROAD SUITE A UNIT#2129
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3004
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Country | US
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Telephone | 678-760-4927
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Fax |
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Provider Business Mailing Address
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Address Line | 1564 HERRINGTON RD APT 6112
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7956
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Country | US
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Telephone | 678-760-4927
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Fax |
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Authorized Official
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Title or Position | CRANIAL PROTHESIS SPECIALIST
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Name | JAZMYN MONET GRIFFITH
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Credential | ETC
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Telephone | 678-760-4927
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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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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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