Healthcare Provider Details

I. General information

NPI: 1023855681
Provider Name (Legal Business Name): RUNWAY CURLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 N HIGHLAND AVE NE
ATLANTA GA
30306-4506
US

IV. Provider business mailing address

3082 BONITA SPRINGS CT
DOUGLASVILLE GA
30135-9239
US

V. Phone/Fax

Practice location:
  • Phone: 404-832-0801
  • Fax:
Mailing address:
  • Phone: 404-630-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MUSHIYA TSHIKUKA
Title or Position: CEO
Credential:
Phone: 404-630-4772