Provider Demographics
NPI:1104211879
Name:HAIR & BEAUTY TREATMENT CENTER
Entity Type:Organization
Organization Name:HAIR & BEAUTY TREATMENT CENTER
Other - Org Name:SOUTHERN COMFORT MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRIN-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-373-9184
Mailing Address - Street 1:505 PACIFICA DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1757
Mailing Address - Country:US
Mailing Address - Phone:706-373-9184
Mailing Address - Fax:
Practice Address - Street 1:524 SHARTOM DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4751
Practice Address - Country:US
Practice Address - Phone:706-373-9184
Practice Address - Fax:762-333-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X, 332B00000X
261QH0100X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1548654411OtherNPI