Provider Demographics
NPI:1003190927
Name:ATLANTIC BRACE LLC
Entity Type:Organization
Organization Name:ATLANTIC BRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-280-8565
Mailing Address - Street 1:8360 SIX FORKS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5077
Mailing Address - Country:US
Mailing Address - Phone:919-741-3993
Mailing Address - Fax:
Practice Address - Street 1:6900 SIX FORKS RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6427
Practice Address - Country:US
Practice Address - Phone:919-429-8157
Practice Address - Fax:919-845-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000221286332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies