Healthcare Provider Details

I. General information

NPI: 1518036920
Provider Name (Legal Business Name): SIDNEY J BARNES-O'GORMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 ROSWELL RD NE STE 140
ATLANTA GA
30305-1836
US

IV. Provider business mailing address

3155 ROSWELL RD NE STE 140
ATLANTA GA
30305-1836
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-1000
  • Fax: 404-231-5546
Mailing address:
  • Phone: 404-231-1000
  • Fax: 404-231-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIRO02094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: