Provider Demographics
NPI:1013361039
Name:ROGERS HAIR LOSS CENTER LLC
Entity Type:Organization
Organization Name:ROGERS HAIR LOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AKILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:678-598-6433
Mailing Address - Street 1:75 GREENFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-8873
Mailing Address - Country:US
Mailing Address - Phone:678-598-6433
Mailing Address - Fax:
Practice Address - Street 1:75 GREENFIELD WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-8873
Practice Address - Country:US
Practice Address - Phone:678-598-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier