MEDICARE: MRS. SONYA POWELL TAYLOR CERTIFIED HAIR LOSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management	CO085059	GA

General Provider Information

NPI Number	:	1386141877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONYA POWELL TAYLOR CERTIFIED HAIR LOSS

Provider Business Mailing Address
First Line	:	815 DAN BRINSON RD
Second Line	:
City	:	LUMPKIN
State	:	GA
Zip	:	31815-5211
Country	:	US
Telephone Number	:	706-570-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	4922 ARMOUR RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5233
Country	:	US
Telephone Number	:	706-323-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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