Organization
TO THE ROOT OF THINGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDIE NICHOL JACKSON (HAIR LOSS SPECIALIST)
(770) 256-8467
Entity
Organization
Contact information
Practice address
6077 BENA CT, UNION CITY, GA 30291-1044
(770) 256-8467
Mailing address
6077 BENA CT, UNION CITY, GA 30291-1044
(770) 256-8467
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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