Provider Demographics
NPI:1598058257
Name:EPWAVE, LLC
Entity Type:Organization
Organization Name:EPWAVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LALISSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERGA
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:770-734-3876
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-0094
Mailing Address - Country:US
Mailing Address - Phone:770-734-3876
Mailing Address - Fax:770-234-5103
Practice Address - Street 1:3338 PEACHTREE RD NE
Practice Address - Street 2:SUITE 710
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1026
Practice Address - Country:US
Practice Address - Phone:770-734-3876
Practice Address - Fax:770-234-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty