Provider Demographics
NPI:1164715207
Name:DEERING, MONIQUE RACHELLE (TRICHOLOGIST / HLP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RACHELLE
Last Name:DEERING
Suffix:
Gender:F
Credentials:TRICHOLOGIST / HLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3725
Mailing Address - Country:US
Mailing Address - Phone:470-242-4675
Mailing Address - Fax:678-619-5521
Practice Address - Street 1:303 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3725
Practice Address - Country:US
Practice Address - Phone:470-242-4675
Practice Address - Fax:678-619-5521
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies