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General NPI Number Information
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NPI Number | 1154713253
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Entity Type | Organization
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Legal Business Name | KALIE DARNELL HAIR TEAM
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 425 SIGMAN RD NW SUITE 120
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City | CONYERS
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State | GA
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Zip | 30012-3635
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Country | US
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Telephone | 678-520-8392
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Fax |
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Provider Business Mailing Address
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Address Line | 425 SIGMAN RD NW SUITE 120
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City | CONYERS
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State | GA
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Zip | 30012-3635
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Country | US
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Telephone | 678-520-8392
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Fax |
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Authorized Official
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Title or Position | SPECIALIST
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Name | KALIE D RICHARDSON
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Credential | CERTIFIED
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Telephone | 678-520-8392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CO092929
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License Number State | GA
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