Provider Demographics
NPI:1740055698
Name:GOLDEN GLOW SKIN AND BODY
Entity type:Organization
Organization Name:GOLDEN GLOW SKIN AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-230-6261
Mailing Address - Street 1:5808 SHAKESPEARE RD STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5808 SHAKESPEARE RD STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7200
Practice Address - Country:US
Practice Address - Phone:803-753-8792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty