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General NPI Number Information
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NPI Number | 1508784380
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Entity Type | Organization
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Legal Business Name | IMODEL BEAUTY BAR LLC
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 1820 NOAHS ARK RD STE 104
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City | JONESBORO
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State | GA
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Zip | 30236-7455
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Country | US
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Telephone | 470-905-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 PARKWAY CIR
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City | ATLANTA
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State | GA
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Zip | 30349-9403
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Country | US
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Telephone | 470-753-9303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QUINISHA REID
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Credential |
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Telephone | 470-905-3193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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