Provider Demographics
NPI:1164974390
Name:GOLDILOX HAIR HOUSE, INC.
Entity Type:Organization
Organization Name:GOLDILOX HAIR HOUSE, INC.
Other - Org Name:GOLDILOX HAIR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL HAIR LOSS
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-656-1831
Mailing Address - Street 1:1050 CROWN POINTE PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7707
Mailing Address - Country:US
Mailing Address - Phone:800-656-1831
Mailing Address - Fax:
Practice Address - Street 1:1050 CROWN POINTE PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7707
Practice Address - Country:US
Practice Address - Phone:800-656-1831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDILOX HAIR HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137699335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier