Provider Demographics
NPI:1457011744
Name:PLATINUM HAIR BY MERLANDE, LLC
Entity type:Organization
Organization Name:PLATINUM HAIR BY MERLANDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MERLANDE
Authorized Official - Middle Name:LEONNA
Authorized Official - Last Name:PETITHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROTHESIS SP
Authorized Official - Phone:770-771-1981
Mailing Address - Street 1:5975 ROSWELL RD, C-343, FLAT-8
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-771-1981
Mailing Address - Fax:
Practice Address - Street 1:5975 ROSWELL RD, C-343, FLAT-8
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-771-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACO129741OtherMASTER COSMETOLOGY & HAIR LOSS PRACTITIONER