MEDICARE: CREATIVE CONNECTIONS MOBILE BARBERSHOP

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	251V00000X	Voluntary or Charitable Agency
2	171W00000X	Contractor	BR016347	GA

General Provider Information

NPI Number	:	1437250438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE CONNECTIONS MOBILE BARBERSHOP

Provider Business Mailing Address
First Line	:	PO BOX 1662
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 OAKHILL CIRCLE
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-6854
Country	:	US
Telephone Number	:	404-838-5943
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. JAMARR EDWARD RAWLINSON
Credential	:
Telephone Number	:	404-838-5943

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/11/2025

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