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General NPI Number Information
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NPI Number | 1699439935
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Entity Type | Organization
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Legal Business Name | ACE HAIR REJUVENATION AND WELLNESS CLINIC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 214 W MAIN ST STE 214A
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City | SWAINSBORO
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State | GA
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Zip | 30401-3150
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Country | US
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Telephone | 912-245-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 NORTH ST E
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City | VIDALIA
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State | GA
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Zip | 30474-8721
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Country | US
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Telephone | 912-380-2228
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Fax |
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Authorized Official
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Title or Position | TRICHOLOGIST
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Name | JASMINE BYNES
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Credential | MA1,PH1,NTI
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Telephone | 912-245-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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