Provider Demographics
NPI:1679148662
Name:BATES FAMILY HAIR AFFAIR, LLC
Entity Type:Organization
Organization Name:BATES FAMILY HAIR AFFAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DEMETRIA
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:RC, MED
Authorized Official - Phone:803-266-2727
Mailing Address - Street 1:42 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:SC
Mailing Address - Zip Code:29853-5432
Mailing Address - Country:US
Mailing Address - Phone:803-300-0273
Mailing Address - Fax:
Practice Address - Street 1:13192 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-5818
Practice Address - Country:US
Practice Address - Phone:803-266-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment