Provider Demographics
NPI:1881042760
Name:HAIRZONE
Entity Type:Organization
Organization Name:HAIRZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIRLOSS S
Authorized Official - Phone:334-280-3930
Mailing Address - Street 1:3009 MCGEHEE RD
Mailing Address - Street 2:B
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2202
Mailing Address - Country:US
Mailing Address - Phone:334-280-3930
Mailing Address - Fax:
Practice Address - Street 1:3009 MCGEHEE RD
Practice Address - Street 2:B
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2202
Practice Address - Country:US
Practice Address - Phone:334-280-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1497129159OtherCERTIFIED HAIRLOSS SPECIALIST