Healthcare Provider Details

I. General information

NPI: 1770081010
Provider Name (Legal Business Name): UNIQUE CREATIONS HAIR STUDIOS II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 JONESBORO RD
MCDONOUGH GA
30253-3725
US

IV. Provider business mailing address

1924 WEATHERSTAFF LN
MCDONOUGH GA
30253-3072
US

V. Phone/Fax

Practice location:
  • Phone: 470-242-4675
  • Fax: 678-619-5521
Mailing address:
  • Phone: 470-242-4675
  • Fax: 678-619-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberCOSA049674
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE RACHELLE DEERING
Title or Position: OWNER
Credential: HLP, TRICHOLOGIST
Phone: 470-242-4675