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General NPI Number Information
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NPI Number | 1659780393
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS HAIR STUDIO PHASEI,LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 1254 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1402
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Country | US
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Telephone | 770-996-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1402
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Country | US
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Telephone | 770-996-0538
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NACOLIA GIPP
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Credential | HAIR LOSS SPECIALIST
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Telephone | 770-996-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CO84458
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License Number State | GA
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