Provider Demographics
NPI:1255051132
Name:GRACEFUL HARMONY MEDSPA
Entity type:Organization
Organization Name:GRACEFUL HARMONY MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TABIA
Authorized Official - Middle Name:ONI
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:AG-ACNP
Authorized Official - Phone:843-817-1744
Mailing Address - Street 1:2850 ASHLEY PHOSPHATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-4403
Mailing Address - Country:US
Mailing Address - Phone:854-999-4899
Mailing Address - Fax:
Practice Address - Street 1:2850 ASHLEY PHOSPHATE RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-4403
Practice Address - Country:US
Practice Address - Phone:854-999-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty