Provider Demographics
NPI:1083666192
Name:EWING, PORCIA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:PORCIA
Middle Name:DAWN
Last Name:EWING
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 1:7075 COATSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5940
Mailing Address - Country:US
Mailing Address - Phone:678-983-0688
Mailing Address - Fax:770-506-0689
Practice Address - Street 1:147 NORTH AVENUE N.W.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-892-1001
Practice Address - Fax:404-874-3826
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor