Organization
HLCA SALON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WINSTON LIBURD (OWNER)
(404) 750-2378
Entity
Organization
Contact information
Practice address
400 W PEACHTREE ST NW, UNIT# 3413, ATLANTA, GA 30308-3536
(404) 750-2378
(404) 581-5911
Mailing address
400 W PEACHTREE ST NW, UNIT# 3413, ATLANTA, GA 30308-3536
(404) 750-2378
(404) 581-5911
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
COSA053764
GA
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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