Provider Demographics
NPI:1588380489
Name:TOP ELITE EXTENSIONS
Entity type:Organization
Organization Name:TOP ELITE EXTENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REKIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-446-8268
Mailing Address - Street 1:360 PHARR RD NE APT 414
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2391
Mailing Address - Country:US
Mailing Address - Phone:678-446-8268
Mailing Address - Fax:
Practice Address - Street 1:1700 MARIETTA BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3639
Practice Address - Country:US
Practice Address - Phone:678-446-8268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier