Organization · NPI-2

Lilburn Shoe Repair & Pedorthics INC

Durable Medical Equipment & Medical Supplies · Lilburn, GA

NPI number1063564367
StatusActive
Last updated in NPPESFeb 17, 2021

Details

NPI
1063564367
Entity type
Organization (NPI-2)
Legal business name
Lilburn Shoe Repair & Pedorthics INC
Organization subpart
No
Enumeration date
Jan 17, 2007
Certification date
Feb 17, 2021
Last updated
Feb 17, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
332B00000X Durable Medical Equipment & Medical Supplies9914GAYes

Other names

  • Lilburn Shoe Repair And Pedorthics INC (Former Legal Business Name)

Practice location

4760 Lawrenceville Hwy Nw
Suite C-1
Lilburn, GA 30047-3858

Phone 770-931-0823

Mailing address

2605 Sims Crest Ct
Snellville, GA 30078-4161

Phone 770-891-3418

Authorized official

Jackie Yvonne Leandro
Owner
7709310823

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