Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 PHARR COURT NORTH NW SUIT 29
ATLANTA GA
30305-2052
US

IV. Provider business mailing address

3060 PHARR COURT NORTH NW SUIT 29
ATLANTA GA
30305-2052
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-8273
  • Fax: 678-519-4712
Mailing address:
  • Phone: 770-256-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO096835
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO096835
License Number StateGA

VIII. Authorized Official

Name: MYHONEY ALTROVISE STRICKLAND
Title or Position: NON- SURGICAL HAIR REPLACEMENT
Credential: MASTER COSMETOLOGIST
Phone: 770-256-8273