Organization
LIVIRAE LINGERIE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA D DAVIS (MASTECTOMY FIT ORGANIZER)
(770) 429-7004
Entity
Organization
Contact information
Practice address
2975 RING RD NW, KENNESAW, GA 30144-4912
(770) 429-7004
(770) 429-7069
Mailing address
2975 RING RD NW, KENNESAW, GA 30144-4912
(770) 429-7004
(770) 429-7069
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
GA
Other
Enumeration date
06/22/2007
Last updated
07/21/2022
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