Glam She LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

CO131281 Issued in GA

Legal business name

GLAM SHE LLC

Practice address

4070 San Marco Way
Douglasville, GA 30135-2769

Phone

(404) 434-6689

NPI assigned

Feb 9, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Frenchell Jackson, PROTHESIS

Title

Owner

Phone

(404) 434-6689

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1033657143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 SAN MARCO WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 SAN MARCO WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352769",
            "telephone_number": "404-434-6689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLAM SHE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FRENCHELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-434-6689",
        "authorized_official_credential": "PROTHESIS"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": "CO131281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED HAIR LOSS SPECIALIST",
            "identifier": "1744P3200X",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Point of Service in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Point of Service in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.