Healthcare Provider Details

I. General information

NPI: 1740573070
Provider Name (Legal Business Name): THC MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 SPALDING DR STE B
NORCROSS GA
30092-4649
US

IV. Provider business mailing address

6315 SPALDING DR STE B
NORCROSS GA
30092-4649
US

V. Phone/Fax

Practice location:
  • Phone: 770-416-9995
  • Fax: 770-416-9995
Mailing address:
  • Phone: 770-416-9995
  • Fax: 770-416-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FRANK PROCACCINI
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 770-416-9995