Healthcare Provider Details

I. General information

NPI: 1255368916
Provider Name (Legal Business Name): MICHAEL LOUIS GELLMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PEACHTREE ST NE SUITE 160
ATLANTA GA
30309-3023
US

IV. Provider business mailing address

1401 PEACHTREE ST NE SUITE 160
ATLANTA GA
30309-3023
US

V. Phone/Fax

Practice location:
  • Phone: 404-475-0386
  • Fax: 404-475-0443
Mailing address:
  • Phone: 404-475-0386
  • Fax: 404-475-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR005228
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: