Provider Demographics
NPI:1497105282
Name:HLCA SALON
Entity Type:Organization
Organization Name:HLCA SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-750-2378
Mailing Address - Street 1:400 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT# 3413
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3536
Mailing Address - Country:US
Mailing Address - Phone:404-750-2378
Mailing Address - Fax:404-581-5911
Practice Address - Street 1:400 W PEACHTREE ST NW
Practice Address - Street 2:UNIT# 3413
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3536
Practice Address - Country:US
Practice Address - Phone:404-750-2378
Practice Address - Fax:404-581-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOSA053764335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier