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General NPI Number Information
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NPI Number | 1851434476
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Entity Type | Individual
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Provider Name | HARRY ELLSWORTH SIEGRIST III D.C, L.D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1781 VETERANS MEMORIAL HWY STE 1A
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City | AUSTELL
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State | GA
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Zip | 30168-7965
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Country | US
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Telephone | 770-941-3802
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Fax | 770-739-2020
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Provider Business Mailing Address
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Address Line | 4140 FALCON DR
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City | AUSTELL
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State | GA
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Zip | 30106-3067
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Country | US
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Telephone | 770-941-6063
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Fax | 770-739-2020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 2148
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 4508
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 3452-012
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 645
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 875
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License Number State | FL
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