Provider Demographics
NPI:1447364120
Name:NEVER THE SAME BOUTIQUE
Entity type:Organization
Organization Name:NEVER THE SAME BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MAROIE
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-382-3322
Mailing Address - Street 1:1497 KENNEDY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4159
Mailing Address - Country:US
Mailing Address - Phone:229-382-3322
Mailing Address - Fax:229-382-4044
Practice Address - Street 1:1497 KENNEDY RD
Practice Address - Street 2:SUITE B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4159
Practice Address - Country:US
Practice Address - Phone:229-382-3322
Practice Address - Fax:229-382-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA194870194AMedicaid
GA194870194AMedicaid