Healthcare Provider Details

I. General information

NPI: 1073722849
Provider Name (Legal Business Name): ELLIOTT MARIE HALE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LYNN EARL DC

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 WOODFALL CT
WOODSTOCK GA
30189-6819
US

IV. Provider business mailing address

1210 20TH ST S STE 200
BIRMINGHAM AL
35205-3899
US

V. Phone/Fax

Practice location:
  • Phone: 404-861-5214
  • Fax:
Mailing address:
  • Phone: 470-385-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR0006637
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIR0006637
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006637
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: