Provider Demographics
NPI:1881167344
Name:ANNB HAIR COVE, LLC
Entity type:Organization
Organization Name:ANNB HAIR COVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNTIONEEK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,ED
Authorized Official - Phone:678-972-4662
Mailing Address - Street 1:1128 LORA SMITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1924
Mailing Address - Country:US
Mailing Address - Phone:678-972-4662
Mailing Address - Fax:
Practice Address - Street 1:1128 LORA SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1924
Practice Address - Country:US
Practice Address - Phone:678-744-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty