Healthcare Provider Details

I. General information

NPI: 1649090473
Provider Name (Legal Business Name): ALBANY BEAUTY ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 DAWSON RD STE IJ
ALBANY GA
31707-3227
US

IV. Provider business mailing address

2231 DAWSON RD STE IJ
ALBANY GA
31707-3227
US

V. Phone/Fax

Practice location:
  • Phone: 229-938-2083
  • Fax:
Mailing address:
  • Phone: 229-938-2083
  • Fax: 888-780-7250

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: TAKENYA LACOLE JORDAN
Title or Position: OWNER
Credential:
Phone: 229-938-2083