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General NPI Number Information
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NPI Number | 1679819692
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Entity Type | Organization
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Legal Business Name | TO THE ROOT OF THINGS
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 6077 BENA CT
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City | UNION CITY
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State | GA
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Zip | 30291-1044
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Country | US
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Telephone | 770-256-8467
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Fax |
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Provider Business Mailing Address
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Address Line | 6077 BENA CT
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City | UNION CITY
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State | GA
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Zip | 30291-1044
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Country | US
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Telephone | 770-256-8467
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Fax |
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Authorized Official
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Title or Position | HAIR LOSS SPECIALIST
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Name | BRANDIE NICHOL JACKSON
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Credential |
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Telephone | 770-256-8467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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