Healthcare Provider Details

I. General information

NPI: 1962124602
Provider Name (Legal Business Name): DESIGNERS HAIR STUDIO & HAIR GROWTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WHITLOCK AVE SW STE B
MARIETTA GA
30064-1971
US

IV. Provider business mailing address

3759 MASHIE CT NW
ACWORTH GA
30101-5802
US

V. Phone/Fax

Practice location:
  • Phone: 770-633-8323
  • Fax:
Mailing address:
  • Phone: 770-633-8323
  • 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: CARLA BYRD
Title or Position: OWNER
Credential: SPECIALIST
Phone: 770-633-8323