Provider Demographics
NPI:1568143972
Name:ETHERIC GLO & CO.LLC
Entity Type:Organization
Organization Name:ETHERIC GLO & CO.LLC
Other - Org Name:ETHERIC GLO BEAUTY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-487-6830
Mailing Address - Street 1:10955 JONES BRIDGE RD STE 126
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7343
Mailing Address - Country:US
Mailing Address - Phone:404-260-0077
Mailing Address - Fax:
Practice Address - Street 1:10955 JONES BRIDGE RD STE 126
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-7343
Practice Address - Country:US
Practice Address - Phone:404-260-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ETHERIC GLO & CO. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service