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General NPI Number Information
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NPI Number | 1740548544
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Entity Type | Organization
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Legal Business Name | BUCKHEAD SPINE CLINIC LTD. CO.
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 3155 ROSWELL RD NE STE 140
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City | ATLANTA
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State | GA
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Zip | 30305-1821
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Country | US
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Telephone | 770-820-5807
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 HABERSHAM RD NE APT 333
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City | ATLANTA
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State | GA
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Zip | 30305-5414
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Country | US
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Telephone | 770-820-5807
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS PICKRELL
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Credential | D.C.
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Telephone | 770-820-5807
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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 | CHIR008850
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License Number State | GA
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