Provider Demographics
NPI:1205450954
Name:GAY, MONIQUE D (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:D
Last Name:GAY
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:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-1244
Mailing Address - Country:US
Mailing Address - Phone:678-468-9702
Mailing Address - Fax:
Practice Address - Street 1:2651 FAVOR RD SW # 1G06
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-5241
Practice Address - Country:US
Practice Address - Phone:678-468-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist