Shadae Renee Medical Wigs

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

SHADAE RENEE MEDICAL WIGS

Practice address

10719 Alpharetta Hwy # 1792
Roswell, GA 30076-2432

Phone

(678) 362-6469

Fax

(678) 325-2731

NPI assigned

Aug 6, 2020

Organization subpart

No

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

Authorized official

Name

Shadae Green

Title

Owner

Phone

(678) 362-6469

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1447860150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10719 ALPHARETTA HWY # 1792",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762432",
            "telephone_number": "678-362-6469",
            "fax_number": "678-325-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10719 ALPHARETTA HWY # 1792",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762432",
            "telephone_number": "678-362-6469",
            "fax_number": "678-325-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADAE RENEE MEDICAL WIGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-06",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "SHADAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-362-6469"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "6783252731",
            "affiliation": "N",
            "endpointDescription": "Fax Machine",
            "address_1": "10719 Alpharetta Hwy # 1792",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300762432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Roswell, GA
• Providers in Roswell, 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 Aug 6, 2020; 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.