Provider Demographics
NPI:1730895442
Name:MEDGALORE AESTHETICS & WELLNESS
Entity type:Organization
Organization Name:MEDGALORE AESTHETICS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:678-557-0207
Mailing Address - Street 1:2304 WINGATE RD UNIT 48613
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28331-9005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CONSULTANT PL STE 100-A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3598
Practice Address - Country:US
Practice Address - Phone:919-446-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherNONE