Healthcare Provider Details

I. General information

NPI: 1205589603
Provider Name (Legal Business Name): THE BEAUTY PARLOR SALON AND BOUTIQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 NAPIER AVE STE B
MACON GA
31204-3872
US

IV. Provider business mailing address

PO BOX 14432
MACON GA
31203-4432
US

V. Phone/Fax

Practice location:
  • Phone: 470-269-2109
  • Fax:
Mailing address:
  • Phone: 470-269-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHARLYN HARRIS
Title or Position: OWNER
Credential:
Phone: 470-269-2109