Healthcare Provider Details

I. General information

NPI: 1497212070
Provider Name (Legal Business Name): JUAKESHIA SMITH BATES CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 FOREST AVENUE
MONTGOMERY AL
36106-1005
US

IV. Provider business mailing address

706 FOREST AVENUE
MONTGOMERY AL
36106-1005
US

V. Phone/Fax

Practice location:
  • Phone: 334-649-1427
  • Fax:
Mailing address:
  • Phone: 334-649-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: