Provider Demographics
NPI:1093046161
Name:PAUL, JEFFERY (DC, ATC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ALLGOOD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2243
Mailing Address - Country:US
Mailing Address - Phone:678-369-3757
Mailing Address - Fax:
Practice Address - Street 1:1155 ALLGOOD RD STE 8
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2243
Practice Address - Country:US
Practice Address - Phone:678-369-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0012132255A2300X
GACHIR008613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer