Provider Demographics
NPI:1508655697
Name:6IXTH AVENUE BEAUTY BAR
Entity type:Organization
Organization Name:6IXTH AVENUE BEAUTY BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ARLRAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-627-8209
Mailing Address - Street 1:112 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1436
Mailing Address - Country:US
Mailing Address - Phone:706-524-5016
Mailing Address - Fax:
Practice Address - Street 1:712 BOHLER AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3718
Practice Address - Country:US
Practice Address - Phone:706-627-8209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier