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General NPI Number Information
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NPI Number | 1033657143
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Entity Type | Organization
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Legal Business Name | GLAM SHE LLC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 4070 SAN MARCO WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2769
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Country | US
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Telephone | 404-434-6689
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 SAN MARCO WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2769
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRENCHELL JACKSON
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Credential | PROTHESIS
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Telephone | 404-434-6689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | CO131281
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License Number State | GA
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