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General NPI Number Information
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NPI Number | 1669110920
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Entity Type | Individual
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Provider Name | BRIANNA JENNIFER JAMES COSMETOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1359 MILSTEAD RD NE STE 201
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City | CONYERS
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State | GA
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Zip | 30012-3865
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Country | US
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Telephone | 770-679-9264
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Fax |
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Provider Business Mailing Address
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Address Line | 3503 MCCALLISTER LN
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City | CONYERS
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State | GA
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Zip | 30013-7500
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Country | US
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Telephone | 908-917-6058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CO132578
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License Number State | GA
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