Provider Demographics
NPI:1275007262
Name:DAVISON, BRIANNA MONIQUE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MONIQUE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8922 LINKS DR E APT 204
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2557
Mailing Address - Country:US
Mailing Address - Phone:901-219-1370
Mailing Address - Fax:
Practice Address - Street 1:2725 S MENDENHALL RD STE 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1530
Practice Address - Country:US
Practice Address - Phone:901-219-1370
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 Licenses
StateLicense IDTaxonomies
TN1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management