Organization
PRODIGIOUS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALENCIA ELLIOTT (PRESIDENT)
(404) 563-0137
Entity
Organization
Contact information
Practice address
1103 GALVIN RD S STE L 1/2, BELLEVUE, NE 68005-3002
(470) 275-4896
Mailing address
6707 CHAPARRAL DR, LITHONIA, GA 30038-3105
(470) 275-4896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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