Provider Demographics
NPI:1134004013
Name:THE HAIR RECOVERY CLINIC RX LLC
Entity type:Organization
Organization Name:THE HAIR RECOVERY CLINIC RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:770-560-0262
Mailing Address - Street 1:3293 STONE MOUNTAIN HWY STE G
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6834
Mailing Address - Country:US
Mailing Address - Phone:770-771-0610
Mailing Address - Fax:
Practice Address - Street 1:3293 STONE MOUNTAIN HWY STE G
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6834
Practice Address - Country:US
Practice Address - Phone:770-771-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist