Healthcare Provider Details

I. General information

NPI: 1104546134
Provider Name (Legal Business Name): GRACIOUS HAIR LOSS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 3RD ST
GREENVILLE NC
27858-1807
US

IV. Provider business mailing address

1700 BROOK HOLLOW DR
GREENVILLE NC
27834-1077
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-3588
  • Fax:
Mailing address:
  • Phone: 252-258-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MISS ZAHNA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 252-258-3588