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General NPI Number Information
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NPI Number | 1336673276
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Entity Type | Organization
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Legal Business Name | COSMO B HAIR SALON
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 805 SHARTOM DR
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City | AUGUSTA
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State | GA
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Zip | 30907-4716
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Country | US
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Telephone | 706-829-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SHARTOM DR
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City | AUGUSTA
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State | GA
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Zip | 30907-4716
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | BRITTANY CRAFTON
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Credential | CERTIFIED HAIR LOSS
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Telephone | 706-829-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CO111737
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License Number State | GA
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