Healthcare Provider Details

I. General information

NPI: 1477231470
Provider Name (Legal Business Name): PARIS D MCGHEE HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 MONTICELLO DR
MONTGOMERY AL
36117-1940
US

IV. Provider business mailing address

5941 MONTICELLO DR
MONTGOMERY AL
36117-1940
US

V. Phone/Fax

Practice location:
  • Phone: 334-274-8027
  • Fax:
Mailing address:
  • Phone: 334-274-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number130626
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: