Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIR002454 | GA |
NPI | 1235208943 |
---|---|
Provider Name | Dr. Dennis Dale Hawk |
First Address | Atlanta, GA 30307-1507 |
Second Address | Atlanta, GA 30307-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |