Provider Demographics
NPI:1073141164
Name:CAROLINA PEACH HAIR RESTORATION
Entity Type:Organization
Organization Name:CAROLINA PEACH HAIR RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRICHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:WTS
Authorized Official - Phone:912-777-2517
Mailing Address - Street 1:104 WHITEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4809
Mailing Address - Country:US
Mailing Address - Phone:912-677-2533
Mailing Address - Fax:
Practice Address - Street 1:7370 HODGSON MEMORIAL DR STE D3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2541
Practice Address - Country:US
Practice Address - Phone:912-777-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059806083OtherUNITED HEALTH