MEDICARE: SALON KAIROS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1073178893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALON KAIROS LLC

Provider Business Mailing Address
First Line	:	2260 SEVEN OAKS CIR
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-1441
Country	:	US
Telephone Number	:	770-940-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 HOWELL MILL RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5559
Country	:	US
Telephone Number	:	770-527-8035
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY CALHOUN
Credential	:	MASTER COSMETOGIST
Telephone Number	:	770-940-0428

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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