Healthcare Provider Details

I. General information

NPI: 1588336929
Provider Name (Legal Business Name): HAIR LOSS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 PLEASANT HILL RD NW STE 113A
LILBURN GA
30047-2769
US

IV. Provider business mailing address

465 PLEASANT HILL RD NW STE 113A
LILBURN GA
30047-2769
US

V. Phone/Fax

Practice location:
  • Phone: 404-437-1268
  • Fax:
Mailing address:
  • Phone: 404-437-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARILYN M JOHNSON
Title or Position: CEO
Credential:
Phone: 404-437-1268