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General NPI Number Information
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NPI Number | 1295477149
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Entity Type | Organization
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Legal Business Name | MONA VENUS SKIN CARE LLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2256 NORTHLAKE PKWY STE 204
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City | TUCKER
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State | GA
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Zip | 30084-4004
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Country | US
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Telephone | 404-220-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 4426 HUGH HOWELL RD STE B300
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City | TUCKER
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State | GA
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Zip | 30084-4918
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Country | US
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Telephone | 404-220-8085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VENUS SIMMONS
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Credential | LMT
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Telephone | 404-220-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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