Organization
IAN BRADLEY HAIR SALON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MCCOY CERTIFIED HAIR LOSS (OWNER)
(478) 714-4302
Entity
Organization
Contact information
Practice address
3902 NORTHSIDE DR STE A3, MACON, GA 31210-2459
(478) 845-1210
Mailing address
222 JOYCLIFF CIR, MACON, GA 31211-7040
(478) 845-1210
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
10/10/2017
Last updated
10/18/2022
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