Provider Demographics
NPI:1023557790
Name:TANN & CO. HAIR SALON
Entity Type:Organization
Organization Name:TANN & CO. HAIR SALON
Other - Org Name:TANN & CO HAIR SALON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPERATOR/ SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TANDIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:HAIR LOSS SPECIALIS
Authorized Official - Phone:678-887-0812
Mailing Address - Street 1:3283 BELLS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GEORGIA
Mailing Address - Zip Code:30273
Mailing Address - Country:UM
Mailing Address - Phone:678-489-2784
Mailing Address - Fax:
Practice Address - Street 1:1158 FOREST PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:GA
Practice Address - Zip Code:30260-3464
Practice Address - Country:US
Practice Address - Phone:678-887-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0951491744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty