Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR6892 | GA |
NPI | 1003989567 |
---|---|
Provider Name | Dr. Andrew D'amato JR. |
First Address | Fayetteville, GA 30214-4058 |
Second Address | Fayetteville, GA 30214-4058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 28/10/2009 |