| NPI | 1083936074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY STUART PAUL President 678-436-5866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO008613) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: GA PT005129) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: GA AT001213) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2010-02-18 |