Provider Demographics
NPI:1801402458
Name:WIGS BY SUZETTE HAIR REPLACEMENT CENTER LLC
Entity Type:Organization
Organization Name:WIGS BY SUZETTE HAIR REPLACEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS & HOLISTIC HEALTH PRACTI
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPC/
Authorized Official - Phone:205-578-2334
Mailing Address - Street 1:800 ELLER DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-3193
Mailing Address - Country:US
Mailing Address - Phone:205-503-9916
Mailing Address - Fax:205-479-5711
Practice Address - Street 1:800 ELLER DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-3193
Practice Address - Country:US
Practice Address - Phone:205-503-9916
Practice Address - Fax:205-479-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management