Organization
CAPTIVATING CROWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL KILLINGSWORTH (OWNER)
(770) 506-4247
Entity
Organization
Contact information
Practice address
1325 ROCK QUARRY RD, STOCKBRIDGE, GA 30281-5088
(770) 506-4247
Mailing address
1325 ROCK QUARRY RD, STOCKBRIDGE, GA 30281-5088
(770) 506-4247
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309-628398
—
GA
Enumeration date
10/11/2021
Last updated
04/11/2022
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