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General NPI Number Information
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NPI Number | 1720432974
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Entity Type | Organization
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Legal Business Name | ZEPHYR SALON
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 335 HAMMOND DR
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City | ATLANTA
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State | GA
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Zip | 30328-5020
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Country | US
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Telephone | 404-255-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 3834 BROWN DR
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City | DECATUR
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State | GA
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Zip | 30034-5802
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Country | US
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Telephone | 770-873-6448
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Fax | 770-686-5968
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MRS. DERHYL MIDDLETON
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Credential |
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Telephone | 770-873-6448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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