Organization
HAIR BAKERY BOUTIQUE LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVIDA MARIA ROACH (OWNER)
(843) 224-8684
Entity
Organization
Contact information
Practice address
225 FRANKLIN RD UNIT 3313, SANDY SPRINGS, GA 30342-2752
(843) 224-8684
Mailing address
225 FRANKLIN RD UNIT 3313, SANDY SPRINGS, GA 30342-2752
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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