Organization
SHADAE RENEE MEDICAL WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHADAE GREEN (OWNER)
(678) 362-6469
Entity
Organization
Contact information
Practice address
10719 ALPHARETTA HWY # 1792, ROSWELL, GA 30076-2432
(678) 362-6469
(678) 325-2731
Mailing address
10719 ALPHARETTA HWY # 1792, ROSWELL, GA 30076-2432
(678) 362-6469
(678) 325-2731
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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