Healthcare Provider Details

I. General information

NPI: 1689333668
Provider Name (Legal Business Name): PERRIN DEANDRE ANDERSON CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 TRAVERS ST
ORANGEBURG SC
29115-6908
US

IV. Provider business mailing address

831 TRAVERS ST
ORANGEBURG SC
29115-6908
US

V. Phone/Fax

Practice location:
  • Phone: 803-664-8180
  • Fax:
Mailing address:
  • Phone: 803-664-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: