Provider Demographics
NPI:1487388427
Name:TRANSFORMATION HAIR SOLUTIONS
Entity type:Organization
Organization Name:TRANSFORMATION HAIR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEONDRA
Authorized Official - Middle Name:SHANTAY
Authorized Official - Last Name:MCGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-513-9504
Mailing Address - Street 1:1755 GORDON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5131
Mailing Address - Country:US
Mailing Address - Phone:478-206-2684
Mailing Address - Fax:
Practice Address - Street 1:1755 GORDON HWY STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5131
Practice Address - Country:US
Practice Address - Phone:478-206-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty