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General NPI Number Information
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NPI Number | 1689915217
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Entity Type | Organization
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Legal Business Name | THE VIVICARE CLINIC P-C
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 4920 ROSWELL RD. ST. 39
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City | ATLANTA
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State | GA
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Zip | 30342-2636
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Country | US
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Telephone | 404-963-1913
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Fax | 404-963-1947
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Provider Business Mailing Address
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Address Line | 4920 ROSWELL RD. ST. 39
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City | ATLANTA
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State | GA
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Zip | 30342-2636
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Country | US
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Telephone | 404-963-1913
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Fax | 404-963-1947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICOLE KHALILAH WILLIAMS
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Credential | DC
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Telephone | 404-963-1913
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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 | CHIR008939
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License Number State | GA
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