| NPI | 1124243704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL LYNN MIDDLETON Billing Manager 770-850-0857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO008139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052963) |
| 207Q00000X Family Medicine (Licence: GA 042114) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |