# GGSKINLASERHAIR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467051409
- **Authorized official:** KELLY GOODMAN NP (NURSE PRACTIONER / OWNER)
- **Authorized official phone:** (202) 684-7167

## Contact information

- **Practice address:** 4701 SANGAMORE RD STE S207, BETHESDA, MD 20816-2529
- **Practice address phone:** (202) 684-7167
- **Practice address fax:** (240) 483-0441
- **Mailing address:** 4701 SANGAMORE RD STE S207, BETHESDA, MD 20816-2529
- **Mailing address phone:** (202) 684-7167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/21/2020
- **Last updated:** 02/10/2021