MEDICARE: DR. ROBERT MARTIN LEFFEW III DC

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	CHIR010492	GA

General Provider Information

NPI Number	:	1518625821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MARTIN LEFFEW III DC

Provider Business Mailing Address
First Line	:	3000 WINDY HILL RD SE STE 204
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8430
Country	:	US
Telephone Number	:	770-988-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 WINDY HILL RD SE STE 204
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8430
Country	:	US
Telephone Number	:	770-988-8884
Fax Number	:	770-988-8049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/03/2021

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