MEDICARE: MC GRATH COMMUNITY CHIROPRACTIC

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	261QM2500X	Medical Specialty Clinic/Center	CHIR001184	GA

General Provider Information

NPI Number	:	1992139240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MC GRATH COMMUNITY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	110 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	678-489-6690
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 NW BROAD ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1436
Country	:	US
Telephone Number	:	678-489-6690
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN WAYNE MCGRATH
Credential	:	D.C.
Telephone Number	:	678-296-3938

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	11/13/2013

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