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General NPI Number Information
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NPI Number | 1780034454
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Entity Type | Organization
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Legal Business Name | VOLUMINOUS VIRGIN HAIR BOUTIQUE
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 445 ELMA G MILES PKWY 207
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City | HINESVILLE
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State | GA
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Zip | 31313-3230
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Country | US
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Telephone | 912-877-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 445 EG.MILES PARKWAY 207
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City | HINESVILLE
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State | GA
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Zip | 31313-9623
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Country | US
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Telephone | 912-877-7797
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | KENYA DOMINIC
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Credential |
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Telephone | 912-877-7797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 20725
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License Number State | GA
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