MEDICARE: INTIMATE TOUCH SALON /NONE SURGICAL HAIR REPLACEMENT

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	335E00000X	Prosthetic/Orthotic Supplier	CO096835	GA
2	174400000X	Specialist	CO096835	GA

General Provider Information

NPI Number	:	1447599758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTIMATE TOUCH SALON /NONE SURGICAL HAIR REPLACEMENT

Provider Business Mailing Address
First Line	:	3060 PHARR COURT NORTH NW
Second Line	:	SUIT 29
City	:	ATLANTA
State	:	GA
Zip	:	30305-2052
Country	:	US
Telephone Number	:	770-256-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 PHARR COURT NORTH NW
Second Line	:	SUIT 29
City	:	ATLANTA
State	:	GA
Zip	:	30305-2052
Country	:	US
Telephone Number	:	770-256-8273
Fax Number	:	678-519-4712

Authorized Official
Title or Position	:	NON- SURGICAL HAIR REPLACEMENT
Name	:	MYHONEY ALTROVISE STRICKLAND
Credential	:	MASTER COSMETOLOGIST
Telephone Number	:	770-256-8273

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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