MEDICARE: GINGER RENEA POLLARD 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	CO079117	GA

General Provider Information

NPI Number	:	1962949370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER RENEA POLLARD CERTIFIED HAIR LOSS

Provider Business Mailing Address
First Line	:	2111 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7355
Country	:	US
Telephone Number	:	706-617-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7355
Country	:	US
Telephone Number	:	706-617-1111
Fax Number	:

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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