Healthcare Provider Details

I. General information

NPI: 1275007262
Provider Name (Legal Business Name): BRIANNA MONIQUE DAVISON HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S MENDENHALL RD STE 3
MEMPHIS TN
38115-1530
US

IV. Provider business mailing address

8922 LINKS DR E APT 204
MEMPHIS TN
38125-2557
US

V. Phone/Fax

Practice location:
  • Phone: 901-219-1370
  • Fax:
Mailing address:
  • Phone: 901-219-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: