Healthcare Provider Details

I. General information

NPI: 1558927756
Provider Name (Legal Business Name): DOLL LIFE HAIR COLLECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 BUCK CREEK DR
FAIRBURN GA
30213-3116
US

IV. Provider business mailing address

7260 BUCK CREEK DR
FAIRBURN GA
30213-3116
US

V. Phone/Fax

Practice location:
  • Phone: 404-780-6039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREEN FRITH
Title or Position: CEO
Credential:
Phone: 701-335-6985