Healthcare Provider Details

I. General information

NPI: 1871306365
Provider Name (Legal Business Name): JESSE ELIJAH MCCORD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 HIGHWAY 138 NE STE 500
CONYERS GA
30013-1254
US

IV. Provider business mailing address

4169 DORCHESTER DR SE
COVINGTON GA
30014-3137
US

V. Phone/Fax

Practice location:
  • Phone: 770-860-8333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011320
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: