Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 005707 | GA |
N | 111NN1001X | Nutrition | 005707 | GA |
NPI | 1295906535 |
---|---|
Provider Name | Dr. Karen Alicia Locke |
First Address | Griffin, GA 30223-1753 |
Second Address | Griffin, GA 30223-1753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2008 |
Last Update Date | 14/03/2008 |