| |
3 Ravinia Dr, Suite P-160, Atlanta, GA 30346-2118 | |
(770) 392-7160 | |
(770) 392-7163 |
Full Name | |
---|---|
Type | Facility |
Speciality | General Practice |
Location | 3 Ravinia Dr, Atlanta, Georgia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1265711634 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | CHIRO07312 (Georgia) | Secondary |
208D00000X | General Practice | 044023 (Georgia) | Primary |
Mailing Address | Practice Location Address |
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Po Box 501741, Atlanta, GA 31150-1741 Ph: (770) 392-7160 | 3 Ravinia Dr, Suite P-160, Atlanta, GA 30346-2118 Ph: (770) 392-7160 |