Provider Demographics
NPI:1760143689
Name:SMILEY'S HAIR CLINIC LLC
Entity Type:Organization
Organization Name:SMILEY'S HAIR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTECTOMY FITTER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-515-7523
Mailing Address - Street 1:4229 1ST AVE STE E
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4469
Mailing Address - Country:US
Mailing Address - Phone:678-515-7523
Mailing Address - Fax:
Practice Address - Street 1:4229 1ST AVE STE E
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4469
Practice Address - Country:US
Practice Address - Phone:678-515-7523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty