Provider Demographics
NPI:1962978239
Name:BROWN, LATOYA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:BROWN
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 1:1109 S PARK ST STE 504
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4449
Mailing Address - Country:US
Mailing Address - Phone:470-869-1918
Mailing Address - Fax:
Practice Address - Street 1:1109 S PARK ST STE 504
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4449
Practice Address - Country:US
Practice Address - Phone:470-869-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management