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General NPI Number Information
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NPI Number | 1780137844
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Entity Type | Organization
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Legal Business Name | REAL CUSTOM HAIR
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 2451 CUMBERLAND PKWY SE 300-3711
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City | ATLANTA
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State | GA
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Zip | 30339-6136
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Country | US
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Telephone | 678-733-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 2451 CUMBERLAND PKWY SE 300-3711
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City | ATLANTA
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State | GA
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Zip | 30339-6136
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Country | US
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Telephone | 678-733-6466
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NIKKI BELL
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Credential |
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Telephone | 678-733-6466
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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 | CO094395
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License Number State | GA
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