Provider Demographics
NPI:1992402267
Name:ADAMS, MAURENE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:MAURENE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:MAURENE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRICHOLOGIST
Mailing Address - Street 1:1070 MISTLETOE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4312
Mailing Address - Country:US
Mailing Address - Phone:404-907-4590
Mailing Address - Fax:
Practice Address - Street 1:1070 MISTLETOE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4312
Practice Address - Country:US
Practice Address - Phone:404-907-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty