Provider Demographics
NPI:1497386122
Name:KINGDOM CROWNS HAIR STUDIO
Entity Type:Organization
Organization Name:KINGDOM CROWNS HAIR STUDIO
Other - Org Name:KCHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRINA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-308-1104
Mailing Address - Street 1:1533 GREAT SHOALS CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7098
Mailing Address - Country:US
Mailing Address - Phone:678-308-1104
Mailing Address - Fax:
Practice Address - Street 1:316 W PIKE ST STE 202G
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4878
Practice Address - Country:US
Practice Address - Phone:678-308-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy