Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR009744 | GA |
NPI | 1205389574 |
---|---|
Provider Name | Gerald Antoine |
First Address | Marietta, GA 30067-8460 |
Second Address | Sandy Springs, GA 30328-4944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2016 |
Last Update Date | 03/08/2016 |