Healthcare Provider Details

I. General information

NPI: 1255480547
Provider Name (Legal Business Name): JAMES D WADDELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STILLWATER CIR STE C
BONAIRE GA
31005-3856
US

IV. Provider business mailing address

100 STILLWATER CIR STE C
BONAIRE GA
31005-3856
US

V. Phone/Fax

Practice location:
  • Phone: 478-293-4883
  • Fax: 478-293-4886
Mailing address:
  • Phone: 478-293-4883
  • Fax: 478-293-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR004859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: