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General NPI Number Information
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NPI Number | 1114535432
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Entity Type | Organization
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Legal Business Name | BEAUTY ZONE2 MEDICAL WIGS
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 252 KEYS FERRY ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3342
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Country | US
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Telephone | 404-858-1119
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Fax | 470-517-3807
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Provider Business Mailing Address
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Address Line | 252 KEYS FERRY ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3342
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Country | US
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Telephone | 404-858-1119
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Fax | 470-517-3807
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Authorized Official
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Title or Position | OWNER
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Name | LECHOSIA LECHOSIA
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Credential |
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Telephone | 404-858-1119
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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 |
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License Number State |
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