Healthcare Provider Details

I. General information

NPI: 1548304413
Provider Name (Legal Business Name): CAROL LYNN BILLINGSLEY D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 SALEM RD
COVINGTON GA
30016-1863
US

IV. Provider business mailing address

3289 SALEM RD
COVINGTON GA
30016-1863
US

V. Phone/Fax

Practice location:
  • Phone: 770-760-1396
  • Fax: 770-760-7904
Mailing address:
  • Phone: 770-760-1396
  • Fax: 770-760-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR001570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: