Healthcare Provider Details

I. General information

NPI: 1164909586
Provider Name (Legal Business Name): 4K TRESSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 EXECUTIVE BLVD STE 101
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

1008 KENDALE CIR
CHESAPEAKE VA
23322-6872
US

V. Phone/Fax

Practice location:
  • Phone: 404-860-2114
  • Fax: 757-482-4840
Mailing address:
  • Phone: 404-860-2114
  • Fax: 757-482-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: NYKOI R POTTS-SLOWE
Title or Position: CEO
Credential:
Phone: 404-860-2114