Provider Demographics
NPI:1598225534
Name:HARRIS, TAKARA N (TRICHOLOGIST)
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:N
Last Name:HARRIS
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 1:172 SAINT IVES DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8917
Mailing Address - Country:US
Mailing Address - Phone:912-312-7272
Mailing Address - Fax:
Practice Address - Street 1:3766 US HIGHWAY 17 STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8872
Practice Address - Country:US
Practice Address - Phone:921-312-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO124945174400000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174400000XOther Service ProvidersSpecialist