=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902764178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPOSURE HAIR STUDIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11132 MEDLOCK BRIDGE RD
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-406-6975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11132 MEDLOCK BRIDGE RD
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-406-6975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TASHA N CRISS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-270-8107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------