Lilburn Shoe Repair And Pedorthics Inc

NPI 1063564367 - Durable Medical Equipment & Medical Supplies - 332B00000X

NPI Details
NPI 1063564367
Enumeration Date 01/17/2007
Last Updated 07/09/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name JACKIE YVONNE JACKIE
Position OWNER
Phone (770) 931-0823
Fax
Practice Location
4760 LAWRENCEVILLE HWY NW
SUITE C-1
LILBURN GA, 30047-3858, US
Phone (770) 931-0823
Fax
Business Location
4760 LAWRENCEVILLE HWY NW
SUITE C-1
LILBURN GA, 30047-3858, US
Phone (770) 931-0823
Fax
Toxanomy
Taxonomy Code 332B00000X
License State Georgia
License Number 9914
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According to our database, Lilburn Shoe Repair And Pedorthics Inc NPI is 1063564367, taxonomy code is 332B00000X and license number is 9914, license state is located at Georgia. Lilburn Shoe Repair And Pedorthics Inc physically located at 4760 Lawrenceville Hwy Nw, Lilburn GA, 30047-3858. NPI Number 1033115704 has the healthcare provider type.

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1063564367 NPI number is provided on an as is basis without warranty of any kind. 1063564367 is maintained by the National Plan & Provider Enumeration System. The contents of Lilburn Shoe Repair And Pedorthics Inc are for informational purposes only.