Provider Demographics
NPI:1205130143
Name:HAIR PRESCRIPTIONS HEALTH AND WELLNESS REPLACEMENT CENTER
Entity type:Organization
Organization Name:HAIR PRESCRIPTIONS HEALTH AND WELLNESS REPLACEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-907-1420
Mailing Address - Street 1:6944 HIGHWAY 85 STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2960
Mailing Address - Country:US
Mailing Address - Phone:770-907-1420
Mailing Address - Fax:
Practice Address - Street 1:8488 CARLTON RD
Practice Address - Street 2:6944 A HWY 85, RIVERDALE, GA. 30274 (BUSINESS LOCATION)
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1282
Practice Address - Country:US
Practice Address - Phone:770-907-1420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOSA034706335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier