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General NPI Number Information
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NPI Number | 1518599224
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Entity Type | Organization
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Legal Business Name | SALON INTERNATIONAL LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 1070 MISTLETOE RD
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City | DECATUR
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State | GA
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Zip | 30033-4312
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Country | US
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Telephone | 770-809-1337
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 MISTLETOE RD
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City | DECATUR
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State | GA
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Zip | 30033-4312
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Country | US
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Telephone | 770-809-1337
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MAURENE ADAMS
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Credential |
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Telephone | 404-997-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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