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General NPI Number Information
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NPI Number | 1588079818
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Entity Type | Organization
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Legal Business Name | SPORTS DOC LLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 2505 NEWPOINT PKWY STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6003
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Country | US
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Telephone | 770-271-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 NEWPOINT PKWY STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6003
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Country | US
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Telephone | 770-271-3188
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. EVELYN HIGGINS
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Credential | DC
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Telephone | 770-271-3188
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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 | 3034
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License Number State | GA
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