MEDICARE: LIFE OF GEORGIA CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1346	GA

General Provider Information

NPI Number	:	1083936108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE OF GEORGIA CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE B-3
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-346-7093
Fax Number	:	404-346-1010

Provider Business Practice Location Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE B-3
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-346-7093
Fax Number	:	404-346-1010

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM O WALKER
Credential	:	D.C.
Telephone Number	:	404-346-7093

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/16/2010

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