Healthcare Provider Details

I. General information

NPI: 1396875449
Provider Name (Legal Business Name): THADDEUS JAMES LAYTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 FRANKLIN RD SE
MARIETTA GA
30067-8702
US

IV. Provider business mailing address

PO BOX 440036
KENNESAW GA
30160-9501
US

V. Phone/Fax

Practice location:
  • Phone: 770-955-2011
  • Fax: 678-819-1240
Mailing address:
  • Phone: 770-955-2011
  • Fax: 678-819-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: