Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5345 | GA |
NPI | 1225047269 |
---|---|
Provider Name | Colleen Marie Pio |
First Address | Alpharetta, GA 30022-5402 |
Second Address | Snellville, GA 30078-2668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U87808 | (02) | GA |