Individual
MS. MERLANDE LEONNA PETITHOMME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
5975 ROSWELL RD, C-343, FLAT-8, SANDY SPRINGS, GA 30328
(770) 771-1981
Mailing address
5975 ROSWELL RD, C-343, FLAT-8, SANDY SPRINGS, GA 30328
(770) 771-1981
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO129741
MEDICAL INSURANCE
GA
Enumeration date
12/28/2021
Last updated
12/28/2021
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