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General NPI Number Information
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NPI Number | 1205389574
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Entity Type | Individual
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Provider Name | GERALD ANTOINE
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Gender | Male
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 130 ALLEN RD SUITE D
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-4944
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Country | US
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Telephone | 407-952-7309
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 TERRELL MILL RD SE 2C
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City | MARIETTA
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State | GA
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Zip | 30067-8460
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Country | US
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Telephone | 407-952-7309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIR009744
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License Number State | GA
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