Healthcare Provider Details

I. General information

NPI: 1154298305
Provider Name (Legal Business Name): KEZIAH HAIR EXTENSIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HUNT CLIFF POINT
VILLA RICA GA
30180
US

IV. Provider business mailing address

3780 OLD NORCROSS RD STE 103
DULUTH GA
30096-1762
US

V. Phone/Fax

Practice location:
  • Phone: 800-484-4435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEISHA CUMBER
Title or Position: OWNER, CEO
Credential:
Phone: 800-484-4435