Provider Demographics
NPI:1568808491
Name:INTIMATES PLUS LLC
Entity Type:Organization
Organization Name:INTIMATES PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISSANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-906-7759
Mailing Address - Street 1:4865 MICHAEL JAY ST
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7644
Mailing Address - Country:US
Mailing Address - Phone:770-906-7759
Mailing Address - Fax:
Practice Address - Street 1:5900 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7857
Practice Address - Country:US
Practice Address - Phone:770-906-7759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier