Organization
BOHLDFACE BYU-TE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIANA MARCUS (OWNER)
(470) 510-8285
Entity
Organization
Contact information
Practice address
3895 BUSBY MILL CT, ELLENWOOD, GA 30294-2055
(470) 510-8285
Mailing address
3895 BUSBY MILL CT, ELLENWOOD, GA 30294-2055
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
01/08/2021
Last updated
04/30/2024
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