MEDICARE: GLAMORE HAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1174185482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLAMORE HAIR

Provider Business Mailing Address
First Line	:	2275 MARIETTA BLVD NW STE 270-384
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:	404-769-7326
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 MARIETTA BLVD NW STE 270-384
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2004
Country	:	US
Telephone Number	:	404-769-7326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTNEY WHITE
Credential	:
Telephone Number	:	404-769-7326

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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Directions to “GLAMORE HAIR ” Practice Location

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