Healthcare Provider Details

I. General information

NPI: 1942874656
Provider Name (Legal Business Name): STYLES AND ACTION BEAUTY SALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 TOBACCO RD
HEPHZIBAH GA
30815-7001
US

IV. Provider business mailing address

2383 BASSWOOD DR
AUGUSTA GA
30906-9483
US

V. Phone/Fax

Practice location:
  • Phone: 912-531-0694
  • Fax:
Mailing address:
  • Phone: 912-531-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHALONDA A THOMAS
Title or Position: OWNER
Credential:
Phone: 912-531-0694