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General NPI Number Information
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NPI Number | 1073126132
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Entity Type | Organization
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Legal Business Name | COASTAL HAIR LOSS CENTER
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 828 PASS RD STE C
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City | GULFPORT
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State | MS
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Zip | 39501-6437
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Country | US
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Telephone | 228-617-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 34TH ST APT 3D
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City | GULFPORT
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State | MS
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Zip | 39501-6318
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Country | US
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Telephone | 228-617-0908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS DENISHA L WILLIAMS
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Credential | HAIR LOSS SPECIALIST
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Telephone | 228-617-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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