Healthcare Provider Details

I. General information

NPI: 1043497621
Provider Name (Legal Business Name): TRANQUILITY SALON & SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2008
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PARKWAY DR NE 4TH FLOOR
ATLANTA GA
30312-1213
US

IV. Provider business mailing address

320 PARKWAY DR NE 4TH FLOOR
ATLANTA GA
30312-1213
US

V. Phone/Fax

Practice location:
  • Phone: 404-525-6161
  • Fax: 404-525-6164
Mailing address:
  • Phone: 404-525-6161
  • Fax: 404-525-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KAY WALTERS
Title or Position: MANAGER
Credential:
Phone: 404-525-6161