Provider Demographics
NPI:1295351302
Name:GENERAL, MARQUISHA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:MARQUISHA
Middle Name:
Last Name:GENERAL
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3379 PEACHTREE RD NE STE 655-S24
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1031
Mailing Address - Country:US
Mailing Address - Phone:770-580-2380
Mailing Address - Fax:770-628-5144
Practice Address - Street 1:1812 N BROWN RD STE 30
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-1801
Practice Address - Country:US
Practice Address - Phone:770-580-2380
Practice Address - Fax:770-628-5144
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management