Provider Demographics
NPI:1174404784
Name:ARLANA'S MEDICAL WIGS
Entity type:Organization
Organization Name:ARLANA'S MEDICAL WIGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:ARLANA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-474-1407
Mailing Address - Street 1:332 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1510
Mailing Address - Country:US
Mailing Address - Phone:843-474-1407
Mailing Address - Fax:843-474-1407
Practice Address - Street 1:332 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1510
Practice Address - Country:US
Practice Address - Phone:843-474-1407
Practice Address - Fax:843-474-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier