Organization
EXTENSIONS OF U
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIBOMBA DAVENPORT (HAIR LOSS SPECIALIST)
(404) 510-2604
Entity
Organization
Contact information
Practice address
3335 SPRING HILL PKWY SE # 22, SMYRNA, GA 30080
(770) 690-8288
Mailing address
625 CROSSHAVEN DR, MARIETTA, GA 30066-0024
(404) 510-2604
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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