Provider Demographics
NPI:1235722547
Name:MIGNOTT, HEATHER C (TRICHOLOGIST)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:MIGNOTT
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4116
Mailing Address - Country:US
Mailing Address - Phone:305-336-9993
Mailing Address - Fax:
Practice Address - Street 1:908 S MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4966
Practice Address - Country:US
Practice Address - Phone:305-336-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty