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General NPI Number Information
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NPI Number | 1205130143
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Entity Type | Organization
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Legal Business Name | HAIR PRESCRIPTIONS HEALTH AND WELLNESS REPLACEMENT CENTER
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 8488 CARLTON RD 6944 A HWY 85, RIVERDALE, GA. 30274 (BUSINESS LOCATION)
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City | RIVERDALE
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State | GA
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Zip | 30296-1282
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Country | US
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Telephone | 770-907-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 6944 HIGHWAY 85 STE A SUITE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2960
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Country | US
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Telephone | 770-907-1420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CYNTHIA COLE
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Credential |
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Telephone | 770-907-1420
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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 | COSA034706
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License Number State | GA
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