Provider Demographics
NPI:1518421247
Name:GREER-WILKERSON, DAJA MARIE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:DAJA
Middle Name:MARIE
Last Name:GREER-WILKERSON
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 1:1335 HERRINGTON RD APT 1716
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6404
Mailing Address - Country:US
Mailing Address - Phone:317-473-4186
Mailing Address - Fax:
Practice Address - Street 1:1335 HERRINGTON RD APT 1716
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6404
Practice Address - Country:US
Practice Address - Phone:317-473-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management