Provider Demographics
NPI:1629428446
Name:BEYOND THE FOLLICLE HAIR RESTORATION CENTER LLC
Entity Type:Organization
Organization Name:BEYOND THE FOLLICLE HAIR RESTORATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEURENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-691-8815
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0672
Mailing Address - Country:US
Mailing Address - Phone:706-691-8815
Mailing Address - Fax:
Practice Address - Street 1:211 BOBBY JONES EXPY STE C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5253
Practice Address - Country:US
Practice Address - Phone:706-691-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0591531744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty