Healthcare Provider Details

I. General information

NPI: 1437250438
Provider Name (Legal Business Name): CREATIVE CONNECTIONS MOBILE BARBERSHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 OAKHILL CIRCLE
AUSTELL GA
30168-6854
US

IV. Provider business mailing address

PO BOX 1662
LITHIA SPRINGS GA
30122-1173
US

V. Phone/Fax

Practice location:
  • Phone: 404-838-5943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberBR016347
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMARR EDWARD RAWLINSON
Title or Position: OWNER/OPERATOR
Credential:
Phone: 404-838-5943