Modish Beaute LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

MODISH BEAUTE LLC

Practice address

532 Moline Way
Locust Grove, GA 30248-4471

Phone

(321) 863-2589

Fax

(321) 406-1325

NPI assigned

Mar 1, 2023

Organization subpart

No

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

Authorized official

Name

Octavia Lyons

Title

Manager

Phone

(321) 863-2589

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1154020865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 MOLINE WAY",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302484471",
            "telephone_number": "321-863-2589",
            "fax_number": "321-406-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "532 MOLINE WAY",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302484471",
            "telephone_number": "321-863-2589",
            "fax_number": "321-406-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODISH BEAUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "OCTAVIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-863-2589"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "3214061325",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "address_1": "532 Moline Way",
            "city": "Locust Grove",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302484471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.