Healthcare Provider Details

I. General information

NPI: 1649665191
Provider Name (Legal Business Name): MELISSA MCCOY CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 NORTHSIDE DR
MACON GA
31210-2411
US

IV. Provider business mailing address

222 JOYCLIFF CIR
MACON GA
31211-7040
US

V. Phone/Fax

Practice location:
  • Phone: 478-845-1210
  • Fax: 478-210-5078
Mailing address:
  • Phone: 478-845-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO082468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: