MEDICARE: J LIGHT COLLECTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1518659218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J LIGHT COLLECTION LLC

Provider Business Mailing Address
First Line	:	6595 ROSWELL RD STE G-5546
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	470-694-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2383 AKERS MILL RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2503
Country	:	US
Telephone Number	:	470-694-3064
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LAKIA SCOTT
Credential	:
Telephone Number	:	215-715-3250

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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