Provider Demographics
NPI:1700142981
Name:ONE LOOK SALON AND HAIR LOSS CENTER
Entity Type:Organization
Organization Name:ONE LOOK SALON AND HAIR LOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPECIALIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RYKETIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-420-9091
Mailing Address - Street 1:PO BOX 801445
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1218
Mailing Address - Country:US
Mailing Address - Phone:770-420-9091
Mailing Address - Fax:
Practice Address - Street 1:26 AYERS AVE NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2112
Practice Address - Country:US
Practice Address - Phone:770-420-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO090389335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier