Provider Demographics
NPI:1851853865
Name:BRANCH, MARJORIE D (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:D
Last Name:BRANCH
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 1:3708 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-3620
Mailing Address - Country:US
Mailing Address - Phone:901-438-3111
Mailing Address - Fax:
Practice Address - Street 1:949 E BROOKS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3100
Practice Address - Country:US
Practice Address - Phone:901-319-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist