MEDICARE: POTENTIAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR009276	GA

General Provider Information

NPI Number	:	1417374612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTENTIAL HEALTH

Provider Business Mailing Address
First Line	:	400 W PEACHTREE ST NW
Second Line	:	UNIT 801
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	954-531-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 PEACHTREE RD NE
Second Line	:	SUITE D STUDIO 30
City	:	ATLANTA
State	:	GA
Zip	:	30305-2407
Country	:	US
Telephone Number	:	404-734-0509
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENDALL DORION
Credential	:	D.C.
Telephone Number	:	954-531-8881

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “POTENTIAL HEALTH ” Practice Location

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