Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIRO06373 | GA |
NPI | 1003993478 |
---|---|
Provider Name | Dr. Callie Chaffe Mohn |
First Address | Carrollton, GA 30117 |
Second Address | Carrollton, GA 30117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U78927 | (02) |