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General NPI Number Information
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NPI Number | 1023271533
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Entity Type | Organization
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Legal Business Name | BGL HEALTHCARE GROUP
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/04/2008
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Provider Practice Location Address
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Address Line | 870 NORTHSIDE DR NW SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30318-5763
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Country | US
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Telephone | 404-254-1051
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Fax | 404-254-1052
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Provider Business Mailing Address
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Address Line | 870 NORTHSIDE DR NW SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30318-5763
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Country | US
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Telephone | 404-254-1051
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Fax | 404-254-1052
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Authorized Official
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Title or Position | COO/CHIROPRACTOR
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Name | DR. BERNADETTE BIGOMS-LAVENDER
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Credential | D.C.
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Telephone | 404-254-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR006429
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License Number State | GA
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