Lilburn Shoe Repair & Pedorthics Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

9914 Issued in GA

Legal business name

LILBURN SHOE REPAIR & PEDORTHICS INC

Practice address

4760 Lawrenceville Hwy NW
Suite C-1
Lilburn, GA 30047-3858

Phone

(770) 931-0823

NPI assigned

Jan 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jackie Yvonne Leandro

Title

Owner

Phone

(770) 931-0823

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lilburn Shoe Repair and Pedorthics inc Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David John Leandro, C.PED

  • Contractor
  • Lilburn, GA
  • NPI 1053317867
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1063564367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 SIMS CREST CT",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300784161",
            "telephone_number": "770-891-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 LAWRENCEVILLE HWY NW",
            "address_2": "SUITE C-1",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473858",
            "telephone_number": "770-931-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILBURN SHOE REPAIR & PEDORTHICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "LEANDRO",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-931-0823"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "9914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANENTE ID",
            "identifier": "L937",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lilburn Shoe Repair and Pedorthics inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Lilburn Shoe Repair and Pedorthics inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Lilburn Medical Center PC
• Lilburn Pediatrics
• Lilburn Sports Chiropractic Youth Rejuvenation, LLC
• Justin Ho Lim, PHARMD
• Yiming Lin
• Liquid Gold Solutions
• Little by Little Wellness Clinic

• Durable Medical Equipment & Medical Supplies in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.