Healthcare Provider Details

I. General information

NPI: 1104046044
Provider Name (Legal Business Name): URBAN FAMILY CHIROPRACTIC LIFE CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HARRELL DRIVE
GARDEN CITY GA
31408
US

IV. Provider business mailing address

PO BOX 23196
SAVANNAH GA
31403
US

V. Phone/Fax

Practice location:
  • Phone: 912-963-6711
  • Fax: 912-963-6713
Mailing address:
  • Phone: 912-963-6711
  • Fax: 912-963-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO05449
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1934
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO05811
License Number StateGA

VIII. Authorized Official

Name: CONNIE D SINGLETON
Title or Position: DOCTOR
Credential: DC
Phone: 912-963-6711