Provider Demographics
NPI:1699246942
Name:TKHAIR247 LLC
Entity type:Organization
Organization Name:TKHAIR247 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TK
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-760-0484
Mailing Address - Street 1:2146 ROSWELL RD
Mailing Address - Street 2:108-1110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062
Mailing Address - Country:US
Mailing Address - Phone:678-760-0484
Mailing Address - Fax:
Practice Address - Street 1:1 GALLERIA PKWY SE,
Practice Address - Street 2:SUITE 1D2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3008
Practice Address - Country:US
Practice Address - Phone:678-760-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty