Healthcare Provider Details

I. General information

NPI: 1861934747
Provider Name (Legal Business Name): HAIR RESTORATION OF THE SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 GALLERIA DRIVE STE 201
METAIRIE LA
70001
US

IV. Provider business mailing address

3100 GALLERIA DRIVE STE 201
METAIRIE LA
70001
US

V. Phone/Fax

Practice location:
  • Phone: 504-301-4247
  • Fax:
Mailing address:
  • Phone: 504-315-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE ELAINE ROGERS
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 504-315-4247