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General NPI Number Information
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NPI Number | 1770081010
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Entity Type | Organization
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Legal Business Name | UNIQUE CREATIONS HAIR STUDIOS II, LLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 303 JONESBORO RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-3725
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Country | US
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Telephone | 470-242-4675
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Fax | 678-619-5521
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Provider Business Mailing Address
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Address Line | 1924 WEATHERSTAFF LN
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City | MCDONOUGH
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State | GA
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Zip | 30253-3072
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Country | US
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Telephone | 470-242-4675
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Fax | 678-619-5521
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Authorized Official
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Title or Position | OWNER
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Name | MONIQUE RACHELLE DEERING
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Credential | HLP, TRICHOLOGIST
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Telephone | 470-242-4675
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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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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | COSA049674
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License Number State | GA
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