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General NPI Number Information
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NPI Number | 1952562985
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Entity Type | Organization
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Legal Business Name | WELLHEALTH CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 1720 PHOENIX BLVD SUITE 450
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City | ATLANTA
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State | GA
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Zip | 30349-5594
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Country | US
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Telephone | 770-909-0590
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 PHOENIX BLVD SUITE 450
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City | ATLANTA
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State | GA
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Zip | 30349-5594
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Country | US
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Telephone | 770-909-0590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTAURES D JACKSON
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Credential | D.C.
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Telephone | 770-909-0590
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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 | GA006713
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License Number State | GA
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