Organization
EJUAN HAIR REPLACEMENT CENTER
Active
Other names
Ejuan Hair Replacement Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EJUAN DAVIS SMALLWOOD HLS (HAIR LOSS SPECIALIST)
(404) 834-0396
Entity
Organization
Contact information
Practice address
5043 JIMMY LEE SMITH PKWY, HIRAM, GA 30141-2733
(404) 834-0396
Mailing address
19 CENTENNIAL LN, DALLAS, GA 30132-0256
(404) 834-0396
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
CO097738
GA
1744P3200X
Prosthetics Case Management
—
GA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
GA
332BC3200X
Customized Equipment (DME)
—
GA
Other
Enumeration date
09/09/2017
Last updated
09/14/2017
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