MEDICARE: ANTHONY J. NEARY D.C.

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	111NN0400X	Neurology Chiropractor	005252	GA
2	111N00000X	Chiropractor	005252	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202I354310	OTHER	GA	MEDICARE PTAN

General Provider Information

NPI Number	:	1891883088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J. NEARY D.C.

Provider Business Mailing Address
First Line	:	1263 CROWN TER
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-3065
Country	:	US
Telephone Number	:	678-992-1920
Fax Number	:	770-864-9628

Provider Business Practice Location Address
First Line	:	6748 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	678-992-1920
Fax Number	:	770-864-9628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/28/2021

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