Healthcare Provider Details

I. General information

NPI: 1699071662
Provider Name (Legal Business Name): INTEGRITY SPINE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 LAWRENCEVILLE SUWANEE RD SUITE 1C
SUWANEE GA
30024-6542
US

IV. Provider business mailing address

3320 LAWRENCEVILLE SUWANEE RD SUITE 1C
SUWANEE GA
30024-6542
US

V. Phone/Fax

Practice location:
  • Phone: 678-714-5722
  • Fax: 678-714-5724
Mailing address:
  • Phone: 678-714-5722
  • Fax: 678-714-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO007116
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberGA11414
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER L WATERS
Title or Position: OWNER
Credential: D.C.
Phone: 404-317-6364