=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457440968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PERFECT FIT SALON INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 BATTLEFIELD SUITE 120
-----------------------------------------------------
City | RINGGOLD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-858-0710
-----------------------------------------------------
Fax | 706-858-0810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 798 RED BUD RD
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-625-3777
-----------------------------------------------------
Fax | 706-625-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANTHONY BEN GRIFFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-858-0710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------