Provider Demographics
NPI:1437250438
Name:CREATIVE CONNECTIONS MOBILE BARBERSHOP
Entity Type:Organization
Organization Name:CREATIVE CONNECTIONS MOBILE BARBERSHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMARR
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RAWLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-838-5943
Mailing Address - Street 1:PO BOX 1662
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7005 OAKHILL CIRCLE
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-6854
Practice Address - Country:US
Practice Address - Phone:404-838-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABR016347171W00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171W00000XOther Service ProvidersContractorGroup - Single Specialty
Not Answered251V00000XAgenciesVoluntary or Charitable