Healthcare Provider Details

I. General information

NPI: 1730639774
Provider Name (Legal Business Name): SHANIQUA GARCIA HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BEECHER ST SW
ATLANTA GA
30310-2717
US

IV. Provider business mailing address

825 BEECHER ST SW
ATLANTA GA
30310-2717
US

V. Phone/Fax

Practice location:
  • Phone: 404-549-2034
  • Fax:
Mailing address:
  • Phone: 404-549-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: