Provider Demographics
NPI:1669145348
Name:HAIR LOSS CENTER OF ALABAMA
Entity type:Organization
Organization Name:HAIR LOSS CENTER OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAKIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-594-4522
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:NOTASULGA
Mailing Address - State:AL
Mailing Address - Zip Code:36866-0743
Mailing Address - Country:US
Mailing Address - Phone:334-594-4522
Mailing Address - Fax:
Practice Address - Street 1:209 SAMFORD AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-3121
Practice Address - Country:US
Practice Address - Phone:334-594-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies