Organization
HAIR EXTENSION STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALGENICE LIDDELL (CEO)
(404) 723-9721
Entity
Organization
Contact information
Practice address
4485 TENCH RD STE 130, SUWANEE, GA 30024-6738
(404) 723-9721
Mailing address
4485 TENCH RD STE 130, SUWANEE, GA 30024-6738
(404) 723-9721
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
03/13/2013
Last updated
03/15/2013
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