Provider Demographics
NPI:1083836860
Name:CINDERELLA WIGS INC
Entity Type:Organization
Organization Name:CINDERELLA WIGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-861-0801
Mailing Address - Street 1:801 CHICKAMAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-1406
Mailing Address - Country:US
Mailing Address - Phone:706-861-0801
Mailing Address - Fax:706-861-0812
Practice Address - Street 1:801 CHICKAMAUGA AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-1406
Practice Address - Country:US
Practice Address - Phone:706-861-0801
Practice Address - Fax:706-861-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5059840001Medicare NSC