Provider Demographics
NPI:1457030124
Name:I AM DANIE LLC
Entity Type:Organization
Organization Name:I AM DANIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-595-5882
Mailing Address - Street 1:230 18TH ST NW UNIT 11420
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1183
Mailing Address - Country:US
Mailing Address - Phone:404-919-3263
Mailing Address - Fax:
Practice Address - Street 1:1745 PEACHTREE ST NE STE F
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2463
Practice Address - Country:US
Practice Address - Phone:404-919-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier