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General NPI Number Information
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NPI Number | 1881492064
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Entity Type | Organization
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Legal Business Name | HAIRITAGE HOUSE HAIR SALON
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 4501 RUSSELL PKWY STE 9
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8679
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Country | US
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Telephone | 478-599-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 102 FINEGAND PL
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8536
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Country | US
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Telephone | 478-599-9696
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Fax |
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Authorized Official
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Title or Position | OWNER/SPECIALIST
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Name | JILL MYRICK
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Credential | HAIR LOSS SPECIALIST
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Telephone | 346-204-2935
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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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