Organization
DYNASTY ELEGANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA CHRISTIAN (OWNER)
(770) 639-0703
Entity
Organization
Contact information
Practice address
2365 SPRING RD SE, SMYRNA, GA 30080-2632
(770) 639-0703
Mailing address
3661 LAKE ESTATES WAY, ATLANTA, GA 30349-1897
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
07/22/2013
Last updated
07/22/2013
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