Healthcare Provider Details

I. General information

NPI: 1184338253
Provider Name (Legal Business Name): BEFORE & AFTER HAIR SALON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 S FRONTAGE RD STE 1
VICKSBURG MS
39180-5263
US

IV. Provider business mailing address

1808 S FRONTAGE RD STE 1
VICKSBURG MS
39180-5263
US

V. Phone/Fax

Practice location:
  • Phone: 601-661-8326
  • Fax:
Mailing address:
  • Phone: 601-661-8326
  • 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: GEORGIA R. DENT
Title or Position: SPECIALIST
Credential: CERTIFIED HAIR LOSS
Phone: 601-661-8326