Provider Demographics
NPI:1477097376
Name:THE LUXE HAIR BAR
Entity Type:Organization
Organization Name:THE LUXE HAIR BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEETA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-993-0532
Mailing Address - Street 1:2274 SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2097
Mailing Address - Country:US
Mailing Address - Phone:404-993-0532
Mailing Address - Fax:
Practice Address - Street 1:2274 SALEM RD SE
Practice Address - Street 2:SUITE 106-199
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2097
Practice Address - Country:US
Practice Address - Phone:404-993-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1760793616OtherNPI