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General NPI Number Information
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NPI Number | 1427423771
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Entity Type | Organization
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Legal Business Name | EYE KANDY LASHES BEAUTY BAR & BOUTIQUE
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 2365 POWDER SPRINGS RD SW SUITE 1215
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City | MARIETTA
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State | GA
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Zip | 30064-4567
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Country | US
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Telephone | 770-702-5663
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Fax | 678-902-6833
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Provider Business Mailing Address
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Address Line | 2365 POWDER SPRINGS RD SW SUITE 1215
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City | MARIETTA
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State | GA
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Zip | 30064-4567
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Country | US
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Telephone | 770-702-5663
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Fax | 678-902-6833
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Authorized Official
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Title or Position | OWNER
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Name | CORRINE SHARON KNIGHT
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Credential | AMT, CO,
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Telephone | 770-865-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | COSA051935
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License Number State | GA
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