NPIMap

Organization Active NPI

Gifted Creation Restoration Hair Loss Clinic

  • Prosthetics Case Management
  • Midway, GA
National Provider Identifier
1801492210
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetics Case ManagementTaxonomy code 1744P3200X
Legal business name
GIFTED CREATION RESTORATION HAIR LOSS CLINIC
Practice address
150 Butler St Ste D-5
Midway, GA 31320-4575
Phone
(912) 463-2883
Fax
(912) 385-9240
NPI assigned
Dec 10, 2020
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Shonda King, AMCANPI 1255808515
Title
Trichologists
Phone
(912) 463-2883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetics Case Management 1744P3200X NU Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

150 Butler St Ste D-5
Midway, GA 31320-4575

Mailing address

PO Box 641
Midway, GA 31320-0641
Phone (912) 463-2883

National Provider Directory

National Provider Directory

Locations

150 Butler St
Ste D5
Midway, GA 31320
Phone (912) 463-2883

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1801492210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 641",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313200641",
            "telephone_number": "912-463-2883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BUTLER ST STE D-5",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313204575",
            "telephone_number": "912-463-2883",
            "fax_number": "912-385-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIFTED CREATION RESTORATION HAIR LOSS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-10",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "SHONDA",
        "authorized_official_title_or_position": "TRICHOLOGISTS",
        "authorized_official_telephone_number": "912-463-2883",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AMCA"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midway, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.