Provider Demographics
NPI:1902625155
Name:DOUGLAS, SHAQUANA JANEISHA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:SHAQUANA
Middle Name:JANEISHA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 EVERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1249 EVERGREEN TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3115
Practice Address - Country:US
Practice Address - Phone:854-208-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management