Healthcare Provider Details

I. General information

NPI: 1588723498
Provider Name (Legal Business Name): RAY B GASKEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 JOHNSON FERRY RD STE 102
MARIETTA GA
30062-5697
US

IV. Provider business mailing address

3000 JOHNSON FERRY RD STE 102
MARIETTA GA
30062-5697
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:
Title or Position:
Credential:
Phone: