Provider Demographics
NPI:1982297339
Name:LOVE LACE LUXURY WIGS BY MONET
Entity Type:Organization
Organization Name:LOVE LACE LUXURY WIGS BY MONET
Other - Org Name:LOVE LACE LUXURY WIGS BY MONET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRANIAL PROTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAZMYN
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:678-760-4927
Mailing Address - Street 1:1564 HERRINGTON RD APT 6112
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7956
Mailing Address - Country:US
Mailing Address - Phone:678-760-4927
Mailing Address - Fax:
Practice Address - Street 1:2090 LAWRENCEVILLE- SUWANEE ROAD
Practice Address - Street 2:SUITE A UNIT#2129
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3004
Practice Address - Country:US
Practice Address - Phone:678-760-4927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies