Healthcare Provider Details

I. General information

NPI: 1548416605
Provider Name (Legal Business Name): BICKERTON WINSTON CARDWELL III N.D., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WINSTON CARDWELL III ND, MS, LAC

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W CROSSVILLE RD STE 501
ROSWELL GA
30075-2964
US

IV. Provider business mailing address

45 WEST CROSSVILLE ROAD SUITE 501
ROSWELL GA
30075
US

V. Phone/Fax

Practice location:
  • Phone: 770-594-1233
  • Fax: 770-594-0037
Mailing address:
  • Phone: 770-594-1233
  • Fax: 770-594-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1434
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: