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General NPI Number Information
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NPI Number | 1881167344
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Entity Type | Organization
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Legal Business Name | ANNB HAIR COVE, LLC
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1128 LORA SMITH RD
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City | NEWNAN
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State | GA
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Zip | 30265-1924
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Country | US
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Telephone | 678-744-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 LORA SMITH RD
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City | NEWNAN
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State | GA
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Zip | 30265-1924
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Country | US
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Telephone | 678-972-4662
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Fax |
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Authorized Official
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Title or Position | HAIR LOSS SPECIALIST
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Name | MS. ANNTIONEEK BOSTON
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Credential | BS,ED
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Telephone | 678-972-4662
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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