=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013101617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABBASTAR, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 08/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 783 S. MAIN ST. SUITE 10
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-865-1229
-----------------------------------------------------
Fax | 706-865-1229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 783 S. MAIN ST. SUITE 10
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-865-1229
-----------------------------------------------------
Fax | 706-865-1229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD RICHARD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 706-865-1229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | GAOOO2765
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 002765
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------