Healthcare Provider Details

I. General information

NPI: 1326661208
Provider Name (Legal Business Name): JASMINE DIXON HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 AUBURN AVE NE
ATLANTA GA
30312-1544
US

IV. Provider business mailing address

710 WINDSOR PLACE CIR
GRAYSON GA
30017-4910
US

V. Phone/Fax

Practice location:
  • Phone: 404-577-7330
  • Fax:
Mailing address:
  • Phone: 404-421-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: