Organization
SALON NEVAEH CERTIFIED HAIR REPLACEMENT SPECIALIST , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHRONDA BOWMAN PRACTITIONER/HAIR (OWNER)
(912) 826-6518
Entity
Organization
Contact information
Practice address
1214 N COLUMBIA AVE, B, RINCON, GA 31326-6816
(912) 826-6518
Mailing address
1214 N COLUMBIA AVE, B, RINCON, GA 31326-6816
(912) 826-6518
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982065652
TOXONOMY
GA
Enumeration date
04/05/2017
Last updated
04/05/2017
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