Provider Demographics
NPI:1518595479
Name:JACQUE MONAE LLC
Entity Type:Organization
Organization Name:JACQUE MONAE LLC
Other - Org Name:J.MONAE WIGS & HAIR LOSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-599-3145
Mailing Address - Street 1:3984 CHURCH VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8430
Mailing Address - Country:US
Mailing Address - Phone:470-599-3145
Mailing Address - Fax:
Practice Address - Street 1:4955 SUGARLOAF PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8838
Practice Address - Country:US
Practice Address - Phone:470-599-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty