MEDICARE: CROWN BEAUTY TRESSES RX

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	:	1285366781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN BEAUTY TRESSES RX

Provider Business Mailing Address
First Line	:	480 GEORGE WALLACE DR
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35903-2280
Country	:	US
Telephone Number	:	910-260-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 GEORGE WALLACE DR
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35903-2280
Country	:	US
Telephone Number	:	910-260-3147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CATHERINE JEANETTE ANDERSON
Credential	:
Telephone Number	:	256-274-6684

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	07/02/2022

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Directions to “CROWN BEAUTY TRESSES RX ” Practice Location

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