Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR009687 | GA |
NPI | 1003007071 |
---|---|
Provider Name | Dr. Joseph William Mckenna |
First Address | Atlanta, GA 30310-4145 |
Second Address | Atlanta, GA 30310-4145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 17/03/2018 |