Healthcare Provider Details

I. General information

NPI: 1336492982
Provider Name (Legal Business Name): GARY R. ADAMS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HIGHWAY 211 NW STE 2-F, PMB #105
BRASELTON GA
30517-3402
US

IV. Provider business mailing address

2095 HIGHWAY 211 NW STE 3A
BRASELTON GA
30517-3402
US

V. Phone/Fax

Practice location:
  • Phone: 770-307-0968
  • Fax: 770-868-0598
Mailing address:
  • Phone: 770-307-0968
  • Fax: 770-868-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06757
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: