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General NPI Number Information
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NPI Number | 1134004013
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Entity Type | Organization
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Legal Business Name | THE HAIR RECOVERY CLINIC RX LLC
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3293 STONE MOUNTAIN HWY STE G
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City | SNELLVILLE
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State | GA
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Zip | 30078-6834
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Country | US
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Telephone | 770-771-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 3293 STONE MOUNTAIN HWY STE G
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City | SNELLVILLE
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State | GA
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Zip | 30078-6834
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Country | US
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Telephone | 770-771-0610
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY LEE
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Credential | CCP
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Telephone | 770-560-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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Taxonomy #2
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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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