Individual
MAYA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2053 METROPOLITAN PKWY SW STE A, ATLANTA, GA 30315-5926
(404) 600-3830
Mailing address
2973 HEADLAND DR SW STE D, ATLANTA, GA 30311-5434
(404) 600-3830
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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