Healthcare Provider Details

I. General information

NPI: 1205582343
Provider Name (Legal Business Name): PREFERRED CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HAMILTON AVE SE STE C
ATLANTA GA
30312-3778
US

IV. Provider business mailing address

650 HAMILTON AVE SE STE C
ATLANTA GA
30312-3778
US

V. Phone/Fax

Practice location:
  • Phone: 404-888-0666
  • Fax: 404-888-0590
Mailing address:
  • Phone: 404-888-0666
  • Fax: 404-888-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. AUDRA JEAN MORAN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 404-888-0666