Provider Demographics
NPI:1174147938
Name:SALON ASYA MIGNON LLC
Entity type:Organization
Organization Name:SALON ASYA MIGNON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-668-8287
Mailing Address - Street 1:4290 MEMORIAL DR STE B1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1225
Mailing Address - Country:US
Mailing Address - Phone:404-668-8287
Mailing Address - Fax:470-486-6700
Practice Address - Street 1:4290 MEMORIAL DR STE B1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1225
Practice Address - Country:US
Practice Address - Phone:404-668-8287
Practice Address - Fax:470-486-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier