Provider Demographics
NPI:1003989567
Name:D'AMATO, ANDREW JR (DC, BCAO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:D'AMATO
Suffix:JR
Gender:M
Credentials:DC, BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 HWY 314
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4058
Mailing Address - Country:US
Mailing Address - Phone:678-817-4053
Mailing Address - Fax:678-817-4058
Practice Address - Street 1:288 HWY 314
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4058
Practice Address - Country:US
Practice Address - Phone:678-817-4053
Practice Address - Fax:678-817-4058
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR6892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5052Medicare PIN