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General NPI Number Information
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NPI Number | 1346695319
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HAIR SOLUTIONS CORPORATION
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 4840 ROSWELL RD BUILDING A STE 201
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City | ATLANTA
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State | GA
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Zip | 30342-2639
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Country | US
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Telephone | 704-909-9414
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Fax |
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Provider Business Mailing Address
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Address Line | 6923 SHANNON WILLOW RD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28226-1330
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Country | US
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Telephone | 704-909-9414
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN E FASSLER
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Credential | M.D.
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Telephone | 704-909-9414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 068728
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License Number State | GA
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