Provider Demographics
NPI:1124038450
Name:GILES, DOUGLAS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:GILES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3415
Mailing Address - Country:US
Mailing Address - Phone:706-543-2584
Mailing Address - Fax:706-354-0702
Practice Address - Street 1:2425 W BROAD ST
Practice Address - Street 2:STE 2
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3419
Practice Address - Country:US
Practice Address - Phone:706-543-2584
Practice Address - Fax:706-354-0702
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 7421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU94869Medicare UPIN
GA35ZCHGHMedicare PIN