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General NPI Number Information
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NPI Number | 1861848137
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Entity Type | Organization
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Legal Business Name | T. BIBBS HAIR RESTORATION & HEALTHCARE
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 1226 ROYAL DR SW STE B
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City | CONYERS
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State | GA
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Zip | 30094-5926
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Country | US
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Telephone | 470-209-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 1478 EASTMONT DR NW
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City | CONYERS
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State | GA
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Zip | 30012-3553
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Country | US
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Telephone | 678-320-7474
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Fax |
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Authorized Official
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Title or Position | TRICHOLOGIST/HAIR LOSS PRACTITIONER
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Name | TENISHA YVONNE BIBBS
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Credential |
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Telephone | 470-209-4671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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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 |
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License Number State |
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