Provider Demographics
NPI:1144794124
Name:HUNTER, TAKERIA TASHAY (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MS
First Name:TAKERIA
Middle Name:TASHAY
Last Name:HUNTER
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SIGNATURE TRCE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2540
Mailing Address - Country:US
Mailing Address - Phone:678-392-7436
Mailing Address - Fax:
Practice Address - Street 1:2621 CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3142
Practice Address - Country:US
Practice Address - Phone:678-392-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management