Organization
HAIR & BEAUTY TREATMENT CENTER
Active
Other names
Southern Comfort Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
DONECIA PERRIN-SULLIVAN (OWNER)
(706) 373-9184
Entity
Organization
Contact information
Practice address
524 SHARTOM DR, AUGUSTA, GA 30907-4751
(706) 373-9184
(762) 333-8798
Mailing address
505 PACIFICA DR, MARTINEZ, GA 30907-1757
(706) 373-9184
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
GA
261QH0100X
Health Service Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548654411
NPI
GA
Enumeration date
03/31/2015
Last updated
11/01/2022
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