Organization
CRYOGEN PLUS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYNISHA ASTREL (OWNER)
(470) 428-2139
Entity
Organization
Contact information
Practice address
1039 GRANT ST SE BLDG A, ATLANTA, GA 30315-2014
(470) 428-2139
Mailing address
461 SANDY CREEK RD STE 41262, FAYETTEVILLE, GA 30214-4290
(267) 973-3005
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20190026
LICENSE
GA
Enumeration date
05/11/2020
Last updated
05/20/2020
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