Healthcare Provider Details

I. General information

NPI: 1629428446
Provider Name (Legal Business Name): BEYOND THE FOLLICLE HAIR RESTORATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BOBBY JONES EXPY STE C
MARTINEZ GA
30907-5253
US

IV. Provider business mailing address

PO BOX 672
AUGUSTA GA
30903-0672
US

V. Phone/Fax

Practice location:
  • Phone: 706-691-8815
  • Fax:
Mailing address:
  • Phone: 706-691-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO059153
License Number StateGA

VIII. Authorized Official

Name: MS. BEURENA JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 706-691-8815