Provider Demographics
NPI:1457789570
Name:JUST BREAST, LLC
Entity Type:Organization
Organization Name:JUST BREAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:SPEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-320-1465
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:708-320-1465
Mailing Address - Fax:404-343-0888
Practice Address - Street 1:1841 HEDGE ROSE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2784
Practice Address - Country:US
Practice Address - Phone:708-320-1465
Practice Address - Fax:404-343-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59206208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty