Provider Demographics
NPI:1497148985
Name:THE BEAUTY BAR
Entity Type:Organization
Organization Name:THE BEAUTY BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CLESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-227-6279
Mailing Address - Street 1:4706 BRAINERD RD
Mailing Address - Street 2:SUITE115
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3829
Mailing Address - Country:US
Mailing Address - Phone:423-227-6279
Mailing Address - Fax:
Practice Address - Street 1:3851 RAE TRL
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-2761
Practice Address - Country:US
Practice Address - Phone:423-227-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment