Healthcare Provider Details

I. General information

NPI: 1285341636
Provider Name (Legal Business Name): HAIR & BEAUTY TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 SHARTOM DR
AUGUSTA GA
30907-4751
US

IV. Provider business mailing address

524 SHARTOM DR
AUGUSTA GA
30907-4751
US

V. Phone/Fax

Practice location:
  • Phone: 706-373-9184
  • Fax: 762-333-8798
Mailing address:
  • Phone: 706-373-9184
  • Fax: 762-333-8798

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: DONECIA PERRIN-SULLIVAN
Title or Position: OWNER
Credential:
Phone: 706-373-9184