Healthcare Provider Details

I. General information

NPI: 1669536082
Provider Name (Legal Business Name): CHATEAU SPINAL REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2095 HIGHWAY 211 NW SUITE 2-F #105
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006757
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number052852
License Number StateGA

VIII. Authorized Official

Name: GARY R ADAMS
Title or Position: OWNER
Credential: DC
Phone: 770-307-0968