Provider Demographics
NPI:1235816182
Name:ATLANTA HAIR DISPENSARY
Entity Type:Organization
Organization Name:ATLANTA HAIR DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-247-4177
Mailing Address - Street 1:2100 DEFOORS FERRY RD NW # 2052
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2391
Mailing Address - Country:US
Mailing Address - Phone:281-247-4177
Mailing Address - Fax:
Practice Address - Street 1:1700 NORTHSIDE DR NW STE A7
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2695
Practice Address - Country:US
Practice Address - Phone:844-404-7584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier