Provider Demographics
NPI:1851061741
Name:JAPINSTIUTE OF WEAVEOLOGY
Entity Type:Organization
Organization Name:JAPINSTIUTE OF WEAVEOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVON
Authorized Official - Middle Name:ANTWANE
Authorized Official - Last Name:PINELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:WEAVE AND WIG MAKER
Authorized Official - Phone:404-990-6824
Mailing Address - Street 1:31 HIGHWAY 138 W STE 320
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4235
Mailing Address - Country:US
Mailing Address - Phone:404-990-6824
Mailing Address - Fax:229-210-3350
Practice Address - Street 1:31 HIGHWAY 138 W STE 320
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4235
Practice Address - Country:US
Practice Address - Phone:404-990-6824
Practice Address - Fax:229-210-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier