Provider Demographics
NPI:1003282849
Name:PRATHER, ANGELIC J (DC)
Entity Type:Individual
Prefix:
First Name:ANGELIC
Middle Name:J
Last Name:PRATHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-0307
Mailing Address - Country:US
Mailing Address - Phone:678-432-4755
Mailing Address - Fax:678-432-4753
Practice Address - Street 1:1619 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2277
Practice Address - Country:US
Practice Address - Phone:678-432-4755
Practice Address - Fax:678-432-4753
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR009556OtherSTATE LICENSE