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General NPI Number Information
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NPI Number | 1881042760
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Entity Type | Organization
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Legal Business Name | HAIRZONE
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 3009 MCGEHEE RD B
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City | MONTGOMERY
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State | AL
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Zip | 36111-2202
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Country | US
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Telephone | 334-280-3930
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 MCGEHEE RD B
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City | MONTGOMERY
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State | AL
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Zip | 36111-2202
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Country | US
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Telephone | 334-280-3930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNAIL FORT
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Credential | CERTIFIED HAIRLOSS S
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Telephone | 334-280-3930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 59208
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License Number State | AL
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