Organization
LILBURN SHOE REPAIR & PEDORTHICS INC
Active
Other names
Lilburn Shoe Repair and Pedorthics inc
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE YVONNE LEANDRO (OWNER)
(770) 931-0823
Entity
Organization
Contact information
Practice address
4760 LAWRENCEVILLE HWY NW, SUITE C-1, LILBURN, GA 30047-3858
(770) 931-0823
Mailing address
2605 SIMS CREST CT, SNELLVILLE, GA 30078-4161
(770) 891-3418
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
9914
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L937
KAISER PERMANENTE ID
GA
Enumeration date
01/17/2007
Last updated
02/17/2021
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