Provider Demographics
NPI:1750945044
Name:BAKER, AYESHA AMEERAH AFRAH (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:AMEERAH AFRAH
Last Name:BAKER
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 1:3645 MARKETPLACE BLVD STE 130-490
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:678-508-8859
Mailing Address - Fax:
Practice Address - Street 1:587 WHITEHALL ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3721
Practice Address - Country:US
Practice Address - Phone:678-365-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1041711744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management