Voluminous Virgin Hair Boutique

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

20725 Issued in GA

Legal business name

VOLUMINOUS VIRGIN HAIR BOUTIQUE

Practice address

445 Elma G Miles Pkwy
207
Hinesville, GA 31313-3230

Phone

(912) 877-7797

NPI assigned

Jun 14, 2016

Last updated

Jun 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenya DominicNPI 1760907968

Title

Member Manager

Phone

(912) 877-7797

Specialties & licenses 1

Addresses

Other names 1

• Sou Consultants Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenya Dominic, HAIR LOSS SPECIALIST

  • Prosthetics Case Management
  • Hinesville, GA
  • NPI 1760907968
  NPD (past) Authorized official

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1780034454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 EG.MILES PARKWAY",
            "address_2": "207",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313139623",
            "telephone_number": "912-877-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 ELMA G MILES PKWY",
            "address_2": "207",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133230",
            "telephone_number": "912-877-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VOLUMINOUS VIRGIN HAIR BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "DOMINIC",
        "authorized_official_first_name": "KENYA",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "912-877-7797"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "20725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sou Consultants",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lauren Vasquez, OTD, OTR
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• Jessica Foxworth Wade, DPT
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• Wal-Mart Stores East LP (Walmart Pharmacy 10-4525)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4519)

• Durable Medical Equipment & Medical Supplies in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; 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.