Organization
MODISH BEAUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVIA LYONS (MANAGER)
(321) 863-2589
Entity
Organization
Contact information
Practice address
532 MOLINE WAY, LOCUST GROVE, GA 30248-4471
(321) 863-2589
(321) 406-1325
Mailing address
532 MOLINE WAY, LOCUST GROVE, GA 30248-4471
(321) 863-2589
(321) 406-1325
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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