Healthcare Provider Details

I. General information

NPI: 1962010645
Provider Name (Legal Business Name): HAIR & SCALP RESTORATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 12/15/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BRIARWOOD DR STE 102
JACKSON MS
39206-3027
US

IV. Provider business mailing address

726 W MADISON ST
YAZOO CITY MS
39194-3483
US

V. Phone/Fax

Practice location:
  • Phone: 662-590-6605
  • Fax: 769-922-5992
Mailing address:
  • Phone: 662-590-6605
  • Fax: 769-022-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MEKO CARTER
Title or Position: OWNER
Credential:
Phone: 662-590-6605