=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912200270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARMAINE ANTONIA HERMAN D.C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 05/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1122 CAMBRIDGE SQ SUITE A
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-393-8833
-----------------------------------------------------
Fax | 678-393-8020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 CAMBRIDGE SQ SUITE A
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-393-8833
-----------------------------------------------------
Fax | 678-393-8020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008584
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NT0100X
-----------------------------------------------------
Taxonomy Name | Thermography Chiropractor
-----------------------------------------------------
License Number | CHIR008584
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------