Provider Demographics
NPI:1558073957
Name:HUNNICOMB OF WELLNESS & BEAUTY
Entity Type:Organization
Organization Name:HUNNICOMB OF WELLNESS & BEAUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:505-275-9857
Mailing Address - Street 1:301 MAIN ST STE 2200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-0014
Mailing Address - Country:US
Mailing Address - Phone:504-275-9857
Mailing Address - Fax:504-910-3075
Practice Address - Street 1:301 MAIN ST STE 2200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-0014
Practice Address - Country:US
Practice Address - Phone:504-275-9857
Practice Address - Fax:504-910-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2378821Medicaid