=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013166545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTA SPINAL CORRECTION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2008
-----------------------------------------------------
Last Update Date | 09/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11800 NORTHFALL LN STE 1402
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-7976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-998-1414
-----------------------------------------------------
Fax | 770-998-1470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11800 NORTHFALL LN STE 1402
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-7976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-998-1414
-----------------------------------------------------
Fax | 770-998-1470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC / FOUNDER
-----------------------------------------------------
Name | DR. SEAN GRAY MCWILLIAMS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 770-998-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 005642
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------