Healthcare Provider Details

I. General information

NPI: 1073178893
Provider Name (Legal Business Name): SALON KAIROS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 HOWELL MILL RD NW
ATLANTA GA
30318-5559
US

IV. Provider business mailing address

2260 SEVEN OAKS CIR
CONLEY GA
30288-1441
US

V. Phone/Fax

Practice location:
  • Phone: 770-527-8035
  • Fax:
Mailing address:
  • Phone: 770-940-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CALHOUN
Title or Position: CEO
Credential: MASTER COSMETOGIST
Phone: 770-940-0428