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General NPI Number Information
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NPI Number | 1497121446
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Entity Type | Organization
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Legal Business Name | EN'VISION HAIR AND NAILS LLC
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Dates
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Enumeration Date | 08/13/2015
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 2750 CHAPEL HILL RD STE 800
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1712
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Country | US
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Telephone | 770-942-9931
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 CHAPEL HILL RD STE 800
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1712
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Country | US
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Telephone | 770-942-9931
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | REGINA ALLEN
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Credential |
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Telephone | 786-594-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CO070153
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License Number State | GA
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