Organization
GLAM SHE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRENCHELL JACKSON PROTHESIS (OWNER)
(404) 434-6689
Entity
Organization
Contact information
Practice address
4070 SAN MARCO WAY, DOUGLASVILLE, GA 30135-2769
(404) 434-6689
Mailing address
4070 SAN MARCO WAY, DOUGLASVILLE, GA 30135-2769
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
CO131281
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1744P3200X
CERTIFIED HAIR LOSS SPECIALIST
GA
Enumeration date
02/09/2017
Last updated
02/09/2017
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