Provider Demographics
NPI:1689451932
Name:POR'SHAY HAIR COLLECTION LLC
Entity Type:Organization
Organization Name:POR'SHAY HAIR COLLECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHE'
Authorized Official - Middle Name:QUINCOLA
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFICATE
Authorized Official - Phone:734-686-7523
Mailing Address - Street 1:3535 PEACHTREE RD NE STE 527
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3287
Mailing Address - Country:US
Mailing Address - Phone:734-686-7523
Mailing Address - Fax:404-671-8588
Practice Address - Street 1:3535 PEACHTREE RD NE STE 527
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3287
Practice Address - Country:US
Practice Address - Phone:734-686-7523
Practice Address - Fax:404-671-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies