Healthcare Provider Details

I. General information

NPI: 1619646353
Provider Name (Legal Business Name): SELA STYLEZ HAIR LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 OSSABAW DR
AUGUSTA GA
30906-3351
US

IV. Provider business mailing address

2005 OSSABAW DR
AUGUSTA GA
30906-3351
US

V. Phone/Fax

Practice location:
  • Phone: 706-828-1660
  • Fax:
Mailing address:
  • Phone: 706-828-1660
  • Fax:

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: SERENA OSBORNE
Title or Position: HAIR REPLACEMENT SPECIALIST
Credential:
Phone: 706-828-1660