Organization
TYS CRANIAL PROTHESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIJAQUANIA GARDNER (OWNER)
(252) 814-7136
Entity
Organization
Contact information
Practice address
2400 S MEMORIAL DR STE 3B, GREENVILLE, NC 27834-5031
(252) 814-7136
(252) 302-4975
Mailing address
2400 S MEMORIAL DR STE 3B, GREENVILLE, NC 27834-5031
(252) 814-7136
(252) 302-4975
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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