Provider Demographics
NPI:1750906301
Name:WILLIAMS, DENISHA LOUISE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:DENISHA
Middle Name:LOUISE
Last Name:WILLIAMS
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 1:828 PASS RD STE C
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-6437
Mailing Address - Country:US
Mailing Address - Phone:228-547-4074
Mailing Address - Fax:
Practice Address - Street 1:828 PASS RD STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-6437
Practice Address - Country:US
Practice Address - Phone:228-547-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0013087224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist