Organization
GIFTED CREATION RESTORATION HAIR LOSS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHONDA KING AMCA (TRICHOLOGISTS)
(912) 463-2883
Entity
Organization
Contact information
Practice address
150 BUTLER ST STE D-5, MIDWAY, GA 31320-4575
(912) 463-2883
(912) 385-9240
Mailing address
PO BOX 641, MIDWAY, GA 31320-0641
(912) 463-2883
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
12/10/2020
Last updated
12/10/2020
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