Provider Demographics
NPI:1558667899
Name:AIYANNA, LLC
Entity Type:Organization
Organization Name:AIYANNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-579-0874
Mailing Address - Street 1:76002 GLOVER LN
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2810
Mailing Address - Country:US
Mailing Address - Phone:404-579-0874
Mailing Address - Fax:
Practice Address - Street 1:83 BOB WHITE AVE
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2630
Practice Address - Country:US
Practice Address - Phone:404-579-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy