Provider Demographics
NPI:1346695319
Name:PEDIATRIC HAIR SOLUTIONS CORPORATION
Entity Type:Organization
Organization Name:PEDIATRIC HAIR SOLUTIONS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-909-9414
Mailing Address - Street 1:6923 SHANNON WILLOW RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1330
Mailing Address - Country:US
Mailing Address - Phone:704-909-9414
Mailing Address - Fax:
Practice Address - Street 1:4840 ROSWELL RD
Practice Address - Street 2:BUILDING A STE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2639
Practice Address - Country:US
Practice Address - Phone:704-909-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068728261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service