Organization
FOR YOUR GLORY CRANIAL PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNE GAYTEN (OWNER)
(678) 338-5731
Entity
Organization
Contact information
Practice address
501 W CONGRESS ST, BROOKHAVEN, MS 39601-2721
(678) 338-5731
(678) 338-5731
Mailing address
501 W CONGRESS ST, BROOKHAVEN, MS 39601-2721
(678) 338-5731
(678) 338-5731
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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