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General NPI Number Information
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NPI Number | 1699016279
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Entity Type | Organization
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Legal Business Name | PAMELA RENE LUXURIOUS HAIR SALON
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1151 HAMMOND DR NE SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30346-1524
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Country | US
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Telephone | 404-831-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 HAMMOND DR SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30346
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Country | US
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Telephone | 404-831-8521
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PAMELA RENE HALL
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Credential | MASTER COSMETOLOGIST
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Telephone | 404-831-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | CASA048619
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License Number State | GA
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