Healthcare Provider Details

I. General information

NPI: 1881848398
Provider Name (Legal Business Name): ANTHONY R BARTOLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 WINDY HILL RD SE SUITE 320
MARIETTA GA
30067-8638
US

IV. Provider business mailing address

2359 WINDY HILL RD SE SUITE 320
MARIETTA GA
30067-8638
US

V. Phone/Fax

Practice location:
  • Phone: 770-988-0033
  • Fax: 770-988-0220
Mailing address:
  • Phone: 770-988-0033
  • Fax: 770-988-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: