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General NPI Number Information
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NPI Number | 1558813295
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Entity Type | Organization
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Legal Business Name | SALON LYON , LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 1112 WEST AVE, SE B
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City | CONYERS
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State | GA
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Zip | 30012
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Country | US
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Telephone | 770-648-6187
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 WEST AVE. SE SUITE B
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City | CONYERS
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State | GA
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Zip | 30012
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Country | US
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Telephone | 770-648-6187
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | MRS. ROBIN LENETTE LYONS
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Credential | CHS
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Telephone | 770-648-6187
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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 | CO089141
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CO089141
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License Number State | GA
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