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General NPI Number Information
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NPI Number | 1659564441
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Entity Type | Organization
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Legal Business Name | MDR, INC.
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 1001 OAK RD SW
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City | LILBURN
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State | GA
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Zip | 30047-1891
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Country | US
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Telephone | 770-979-3701
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Fax | 770-979-3702
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Provider Business Mailing Address
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Address Line | 1001 OAK RD SW
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City | LILBURN
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State | GA
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Zip | 30047-1891
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Country | US
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Telephone | 770-979-3701
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Fax | 770-979-3702
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Authorized Official
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Title or Position | CLINIC DIRECTOR/OWNER
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Name | DR. MARSHALL ROTHMAN
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Credential | D.C.
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Telephone | 770-979-3701
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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 | CHIR006223
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License Number State | GA
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