Healthcare Provider Details

I. General information

NPI: 1336491034
Provider Name (Legal Business Name): CML FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715A BASCOMB COML PKWY
WOODSTOCK GA
30189-2466
US

IV. Provider business mailing address

PO BOX 2363
ACWORTH GA
30102-0007
US

V. Phone/Fax

Practice location:
  • Phone: 770-924-9400
  • Fax: 770-924-3100
Mailing address:
  • Phone: 770-924-9400
  • Fax: 770-924-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5917
License Number StateGA

VIII. Authorized Official

Name: DR. CYNTHIA M LOMAX
Title or Position: PRESIDENT
Credential: DC
Phone: 404-992-6524