Healthcare Provider Details

I. General information

NPI: 1164104584
Provider Name (Legal Business Name): INSIDE OUT HAIR SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 10/16/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WHITEHAVEN DRIVE SUITE 116
MARIETTA GA
30064
US

IV. Provider business mailing address

1445 WOODMONT LN NW # 1189
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 770-380-8821
  • Fax: 678-669-1780
Mailing address:
  • Phone: 770-380-8821
  • Fax: 678-669-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHELLY ANN TAYLOR
Title or Position: OWNER
Credential: CRANIAL PROTHESIS
Phone: 770-380-8821