Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR008595 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | CHIR008595 | GA |
NPI | 1215246434 |
---|---|
Provider Name | Dr. Betty Smith-Weldon |
First Address | Tucker, GA 30084-6264 |
Second Address | Tucker, GA 30084-6264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 12/03/2020 |