Provider Demographics
NPI:1194043380
Name:SEXY-N-LACE
Entity type:Organization
Organization Name:SEXY-N-LACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-516-2157
Mailing Address - Street 1:4230 ETOWAH DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3108
Mailing Address - Country:US
Mailing Address - Phone:678-516-2157
Mailing Address - Fax:866-249-3717
Practice Address - Street 1:4230 ETOWAH DR SE
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-3108
Practice Address - Country:US
Practice Address - Phone:678-516-2157
Practice Address - Fax:866-249-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier