Healthcare Provider Details

I. General information

NPI: 1285629253
Provider Name (Legal Business Name): DR. CEDRICK CHRISTOPHER NOEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 CRABAPPLE RD
ROSWELL GA
30075-5812
US

IV. Provider business mailing address

10930 CRABAPPLE RD STE 18
ROSWELL GA
30075-5813
US

V. Phone/Fax

Practice location:
  • Phone: 770-587-2280
  • Fax: 770-587-2286
Mailing address:
  • Phone: 770-587-2280
  • Fax: 770-587-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR007222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: