Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1978 | GA |
NPI | 1396875449 |
---|---|
Provider Name | Dr. Thaddeus James Layton |
First Address | Kennesaw, GA 30160-9501 |
Second Address | Marietta, GA 30067-8702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |