Provider Demographics
NPI:1699169268
Name:WHITBY, MICHELL (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:WHITBY
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 1:750 BACONSFIELD DR
Mailing Address - Street 2:STE 109
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 BACONSFIELD DR
Practice Address - Street 2:STE 109
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1491
Practice Address - Country:US
Practice Address - Phone:478-447-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0927271744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management