Provider Demographics
NPI:1942802251
Name:HAIR REHAB RX
Entity Type:Organization
Organization Name:HAIR REHAB RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-532-9732
Mailing Address - Street 1:3115 PIEDMONT RD NE STE D202
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2526
Mailing Address - Country:US
Mailing Address - Phone:678-532-9732
Mailing Address - Fax:
Practice Address - Street 1:3115 PIEDMONT RD NE STE D202
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2526
Practice Address - Country:US
Practice Address - Phone:678-532-9732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier