Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR009418 | GA |
NPI | 1003214719 |
---|---|
Provider Name | Brandi Whitehouse |
First Address | Atlanta, GA 30318-1169 |
Second Address | Saint Marys, GA 31558-9402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2014 |
Last Update Date | 11/12/2014 |