Healthcare Provider Details

I. General information

NPI: 1487046553
Provider Name (Legal Business Name): ALL ABOUT COLOUR HAIR & NAIL SALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 DAWSON RD UNIT 1
ALBANY GA
31707-2398
US

IV. Provider business mailing address

2404 DAWSON RD UNIT 1
ALBANY GA
31707-2398
US

V. Phone/Fax

Practice location:
  • Phone: 229-888-7773
  • Fax:
Mailing address:
  • Phone: 229-888-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARGIE PAMELA SMITH
Title or Position: OWNER/COSMETOLOGIST
Credential: CERTIFIED HAIR LOSS
Phone: 229-888-7773