Provider Demographics
NPI:1265152383
Name:BREATHE BEAUTY LA
Entity type:Organization
Organization Name:BREATHE BEAUTY LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWAFUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-866-1468
Mailing Address - Street 1:4140 MOORE RD STE B114
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7157
Mailing Address - Country:US
Mailing Address - Phone:678-866-1468
Mailing Address - Fax:
Practice Address - Street 1:4140 MOORE RD STE B114
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7157
Practice Address - Country:US
Practice Address - Phone:678-866-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty