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General NPI Number Information
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NPI Number | 1114381175
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Entity Type | Organization
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Legal Business Name | FAYETTE CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 7208 TARA BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1902
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Country | US
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Telephone | 770-461-2225
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Fax | 404-875-7961
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Provider Business Mailing Address
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Address Line | 1905 WINDHAM PARK NE
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City | ATLANTA
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State | GA
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Zip | 30324-4960
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Country | US
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Telephone | 404-384-3312
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Fax | 404-875-7961
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DR. LINDA H KATZ
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Credential | D.C
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Telephone | 770-461-2225
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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 | 2211
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License Number State | GA
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