1750083267 NPI number — LALAS CRANIAL PROSTHETIC LLC

Table of content: DR. CHARLES PETER MILANI DDS (NPI 1174582837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750083267 NPI number — LALAS CRANIAL PROSTHETIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LALAS CRANIAL PROSTHETIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750083267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2224 JENNY DR, FAIRBURN, GA 30213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
147-030-1951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2224 JENNY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30213-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
147-030-1951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BRIDGES
Authorized Official First Name:
RYKEYLA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
470-301-9510

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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