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General NPI Number Information
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NPI Number | 1417374612
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Entity Type | Organization
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Legal Business Name | POTENTIAL HEALTH
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 3232 PEACHTREE RD NE SUITE D STUDIO 30
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City | ATLANTA
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State | GA
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Zip | 30305-2407
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Country | US
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Telephone | 404-734-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W PEACHTREE ST NW UNIT 801
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City | ATLANTA
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State | GA
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Zip | 30308-3536
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Country | US
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Telephone | 954-531-8881
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENDALL DORION
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Credential | D.C.
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Telephone | 954-531-8881
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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 | CHIR009276
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License Number State | GA
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