Healthcare Provider Details

I. General information

NPI: 1285839167
Provider Name (Legal Business Name): RAYMOND GASKEY D.C. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD STE 810
MARIETTA GA
30062-7028
US

IV. Provider business mailing address

3225 SHALLOWFORD RD STE 810
MARIETTA GA
30062-7028
US

V. Phone/Fax

Practice location:
  • Phone: 770-552-7979
  • Fax: 770-552-1153
Mailing address:
  • Phone: 770-552-7979
  • Fax: 770-552-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR006197
License Number StateGA

VIII. Authorized Official

Name: MS. CECILIA PORREY
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-552-7979