Provider Demographics
NPI:1699439935
Name:ACE HAIR REJUVENATION AND WELLNESS CLINIC
Entity type:Organization
Organization Name:ACE HAIR REJUVENATION AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRICHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MA1,PH1,NTI
Authorized Official - Phone:912-245-9332
Mailing Address - Street 1:1702 NORTH ST E
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8721
Mailing Address - Country:US
Mailing Address - Phone:912-380-2228
Mailing Address - Fax:
Practice Address - Street 1:214 W MAIN ST STE 214A
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3150
Practice Address - Country:US
Practice Address - Phone:912-245-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty