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General NPI Number Information
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NPI Number | 1124245667
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Entity Type | Organization
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Legal Business Name | HYATT FAMILY CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 SATELLITE BLVD NW SUITE D
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City | SUWANEE
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State | GA
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Zip | 30024-7149
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Country | US
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Telephone | 770-237-3300
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Fax | 770-237-3139
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Provider Business Mailing Address
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Address Line | 105 SATELLITE BLVD NW SUITE D
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City | SUWANEE
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State | GA
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Zip | 30024-7149
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Country | US
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Telephone | 770-237-3300
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Fax | 770-237-3139
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAD AVERY HYATT
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Credential | D.C.
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Telephone | 770-237-3300
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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 | 5693
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6040
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License Number State | GA
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