Healthcare Provider Details

I. General information

NPI: 1841896842
Provider Name (Legal Business Name): PHD HAIR SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LOWER ROSWELL RD STE 106
MARIETTA GA
30068-4300
US

IV. Provider business mailing address

4880 LOWER ROSWELL RD STE 106
MARIETTA GA
30068-4300
US

V. Phone/Fax

Practice location:
  • Phone: 404-988-6645
  • Fax:
Mailing address:
  • Phone: 404-988-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MARTHA TANESHA HINES
Title or Position: OWNER / CLINICAL DIRECTOR
Credential:
Phone: 404-988-6645