Provider Demographics
NPI:1255983367
Name:ABC HAIR LOSS SOLUTIONS
Entity type:Organization
Organization Name:ABC HAIR LOSS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-595-9396
Mailing Address - Street 1:2107 N DECATUR RD STE 786
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:678-595-9396
Mailing Address - Fax:
Practice Address - Street 1:720 STONEBRIDGE PARK CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-9061
Practice Address - Country:US
Practice Address - Phone:678-595-9396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty