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General NPI Number Information
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NPI Number | 1164974390
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Entity Type | Organization
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Legal Business Name | GOLDILOX HAIR HOUSE, INC.
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 1050 CROWN POINTE PKWY SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30338-7707
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Country | US
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Telephone | 800-656-1831
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 CROWN POINTE PKWY SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30338-7707
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Country | US
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Telephone | 800-656-1831
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MEDICAL HAIR LOSS
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Name | MRS. HELEN KONOMA
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Credential | RN
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Telephone | 800-656-1831
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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 | RN137699
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License Number State | GA
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