Provider Demographics
NPI:1497232490
Name:WINFREY, PHYLLIS (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:WINFREY
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 1:719 SIR CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1009
Mailing Address - Country:US
Mailing Address - Phone:404-825-6575
Mailing Address - Fax:
Practice Address - Street 1:719 SIR CHARLES DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1009
Practice Address - Country:US
Practice Address - Phone:404-825-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty