Organization
MARY'S MAJESTIC MEDICAL WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOHNSON (CRANIAL PROSTHESIS SPECIALIST)
(321) 603-1761
Entity
Organization
Contact information
Practice address
2589 WILEY AVE, MIMS, FL 32754-4506
(321) 603-1761
(321) 603-1761
Mailing address
3155 COLUMBIA BLVD # 1035, TITUSVILLE, FL 32780-7820
(321) 603-1761
(321) 603-1761
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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