Healthcare Provider Details

I. General information

NPI: 1114039716
Provider Name (Legal Business Name): WILLIAM KENT HOVIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1812
US

IV. Provider business mailing address

1062 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1812
US

V. Phone/Fax

Practice location:
  • Phone: 404-758-5339
  • Fax: 404-758-6511
Mailing address:
  • Phone: 404-758-5339
  • Fax: 404-758-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number02458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: