Provider Demographics
NPI:1346581493
Name:HAIR EXTENSION STUDIO
Entity Type:Organization
Organization Name:HAIR EXTENSION STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALGENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-723-9721
Mailing Address - Street 1:4485 TENCH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6738
Mailing Address - Country:US
Mailing Address - Phone:404-723-9721
Mailing Address - Fax:
Practice Address - Street 1:4485 TENCH RD STE 130
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6738
Practice Address - Country:US
Practice Address - Phone:404-723-9721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier