Provider Demographics
NPI:1336417849
Name:WLJ ENTERPRISES LLC
Entity Type:Organization
Organization Name:WLJ ENTERPRISES LLC
Other - Org Name:SOUTHERN HORIZON MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MAZZILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-643-0201
Mailing Address - Street 1:230 INDUSTRIAL WAY STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8262
Mailing Address - Country:US
Mailing Address - Phone:678-643-0201
Mailing Address - Fax:
Practice Address - Street 1:230 INDUSTRIAL WAY STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8262
Practice Address - Country:US
Practice Address - Phone:678-643-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies