Provider Demographics
NPI:1811888696
Name:CROWN OF GLORY CRANIAL PROSTHETICS
Entity type:Organization
Organization Name:CROWN OF GLORY CRANIAL PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-777-7751
Mailing Address - Street 1:348 LIVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2509
Mailing Address - Country:US
Mailing Address - Phone:334-777-7751
Mailing Address - Fax:334-777-7751
Practice Address - Street 1:348 LIVE OAKS DR
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-2509
Practice Address - Country:US
Practice Address - Phone:334-777-7751
Practice Address - Fax:334-777-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier