Organization
WYLD LILLIES CROWN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM JENNINGS (OWNER)
(706) 726-5406
Entity
Organization
Contact information
Practice address
2763 TOBACCO RD STE E, HEPHZIBAH, GA 30815-7051
(706) 726-5406
Mailing address
2714 DEEN AVE, AUGUSTA, GA 30906-3232
(706) 726-5406
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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