Healthcare Provider Details

I. General information

NPI: 1700138484
Provider Name (Legal Business Name): JPK,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 PEACHTREE RD NE UNIT 1001
ATLANTA GA
30309-1191
US

IV. Provider business mailing address

2233 PEACHTREE RD NE UNIT 1001
ATLANTA GA
30309-1191
US

V. Phone/Fax

Practice location:
  • Phone: 404-333-5917
  • Fax:
Mailing address:
  • Phone: 404-333-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number006177
License Number StateGA

VIII. Authorized Official

Name: SARA BADIE
Title or Position: MANAGER
Credential:
Phone: 404-333-5917