Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2973 | GA |
NPI | 1013014828 |
---|---|
Provider Name | Dr. Mark Patrick |
First Address | Decatur, GA 30032-1226 |
Second Address | Decatur, GA 30032-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 22/04/2008 |