Provider Demographics
NPI:1760258818
Name:BLOWN, LLC
Entity Type:Organization
Organization Name:BLOWN, LLC
Other - Org Name:NOVI TE SCALP AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-708-9090
Mailing Address - Street 1:6001 RIVER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4574
Mailing Address - Country:US
Mailing Address - Phone:706-708-9090
Mailing Address - Fax:
Practice Address - Street 1:6001 RIVER RD STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4574
Practice Address - Country:US
Practice Address - Phone:706-708-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier