=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497102354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO ATLANTA INJURY AND WELLNESS GA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2016
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5615 OLD NATIONAL HWY SUITE E
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-565-0414
-----------------------------------------------------
Fax | 404-565-0560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5615 OLD NATIONAL HWY SUITE E
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-565-0414
-----------------------------------------------------
Fax | 404-565-0560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC
-----------------------------------------------------
Name | DR. ADJEI MENSAH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 404-565-0414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008956
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008881
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------