Provider Demographics
NPI:1558469320
Name:WLJ ENTERPRIZES, LLC
Entity Type:Organization
Organization Name:WLJ ENTERPRIZES, LLC
Other - Org Name:SOUTHERN HORIZONS MEDICAL EQUIP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MAZZILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-643-0201
Mailing Address - Street 1:100 GANTT LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2176
Mailing Address - Country:US
Mailing Address - Phone:678-643-0201
Mailing Address - Fax:678-962-5855
Practice Address - Street 1:100 GANTT LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-2176
Practice Address - Country:US
Practice Address - Phone:678-643-0201
Practice Address - Fax:678-962-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies