Organization
LALAS CRANIAL PROSTHETIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYKEYLA BRIDGES BSN, RN (OWNER)
(470) 301-9510
Entity
Organization
Contact information
Practice address
2224 JENNY DR, FAIRBURN, GA 30213-4532
(147) 030-1951
Mailing address
2224 JENNY DR, FAIRBURN, GA 30213, FAIRBURN, GA 30213
(147) 030-1951
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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