Organization
CUSTOM HAIR EXTENSIONS & HAIR LOSS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLA JONES (CERTIFIED HAIR LOSS SPECIALIST)
(678) 754-3196
Entity
Organization
Contact information
Practice address
3983 LAVISTA RD, SUITE 164, TUCKER, GA 30084-5153
(678) 754-3196
Mailing address
1900 GLENN CLUB DR, APT 1312, STONE MOUNTAIN, GA 30087-3499
(678) 754-3196
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
08/19/2015
Last updated
09/04/2015
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