Provider Demographics
NPI:1194196808
Name:BEYOND THE ROOT HAIR RESTORATION INC
Entity Type:Organization
Organization Name:BEYOND THE ROOT HAIR RESTORATION INC
Other - Org Name:BEYOND THE ROOT HAIR RESTORATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SEBRICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-886-2481
Mailing Address - Street 1:3724 CASTLE PINES LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2841
Mailing Address - Country:US
Mailing Address - Phone:229-886-2481
Mailing Address - Fax:
Practice Address - Street 1:2610 DAWSON RD
Practice Address - Street 2:13
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1682
Practice Address - Country:US
Practice Address - Phone:229-886-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty