Healthcare Provider Details

I. General information

NPI: 1194196808
Provider Name (Legal Business Name): BEYOND THE ROOT HAIR RESTORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 DAWSON RD 13
ALBANY GA
31707-1682
US

IV. Provider business mailing address

3724 CASTLE PINES LN
ALBANY GA
31721-2841
US

V. Phone/Fax

Practice location:
  • Phone: 229-886-2481
  • Fax:
Mailing address:
  • Phone: 229-886-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. SEBRICA T. MOORE
Title or Position: CEO
Credential:
Phone: 229-886-2481