1033940911 NPI number — MRS. ALEXIS JONES CERTIFIED HAIR LOSS

Table of content: MRS. ALEXIS JONES CERTIFIED HAIR LOSS (NPI 1033940911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033940911 NPI number — MRS. ALEXIS JONES CERTIFIED HAIR LOSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
ALEXIS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED HAIR LOSS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033940911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CLINTON CROSSING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31032-5914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-456-4810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4274 GRAY HWY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31032-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-456-4810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X , with the licence number:  CO088286 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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