1437250438 NPI number — CREATIVE CONNECTIONS MOBILE BARBERSHOP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437250438 NPI number — CREATIVE CONNECTIONS MOBILE BARBERSHOP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE CONNECTIONS MOBILE BARBERSHOP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437250438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHIA SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30122-1173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7005 OAKHILL CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30168-6854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-838-5943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAWLINSON
Authorized Official First Name:
JAMARR
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
404-838-5943

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  BR016347 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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