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General NPI Number Information
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NPI Number | 1104350420
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Entity Type | Organization
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Legal Business Name | JERZEYGIRLHAIR SALON
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 8746 ARBORCREEK DR
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City | CHARLOTTE
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State | NC
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Zip | 28269-0542
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Country | US
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Telephone | 704-840-3753
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Fax |
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Provider Business Mailing Address
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Address Line | 3519 MILL COVE CIR APT 201
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City | CHARLOTTE
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State | NC
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Zip | 28262-7518
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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 | CERTIFIED HAIR LOSS SPECIALIST
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Name | MS. MUKHAIRAH HARRIS
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Credential |
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Telephone | 704-497-8176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 80978
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License Number State | NC
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