Healthcare Provider Details

I. General information

NPI: 1508655697
Provider Name (Legal Business Name): 6IXTH AVENUE BEAUTY BAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 BOHLER AVE
AUGUSTA GA
30904-3718
US

IV. Provider business mailing address

112 HOLIDAY DR
MARTINEZ GA
30907-1436
US

V. Phone/Fax

Practice location:
  • Phone: 706-627-8209
  • Fax:
Mailing address:
  • Phone: 706-627-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. ARLEAN J EDWARDS
Title or Position: COO
Credential:
Phone: 706-627-8209