Provider Demographics
NPI:1922538164
Name:HARDAWAY, TRACEY (COSMETOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:HARDAWAY
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:HARDAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NON-SURGICAL HAIR RE
Mailing Address - Street 1:2905 RICH HILL CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7033
Mailing Address - Country:US
Mailing Address - Phone:901-210-7386
Mailing Address - Fax:
Practice Address - Street 1:8596 FARMINGTON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3345
Practice Address - Country:US
Practice Address - Phone:901-210-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist