Provider Demographics
NPI:1164574802
Name:DAVIS, HEATHER MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MARY
Other - Last Name:WHITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3590 CHEROKEE ST NW
Mailing Address - Street 2:STE. 401
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5930
Mailing Address - Country:US
Mailing Address - Phone:770-218-1166
Mailing Address - Fax:770-218-1006
Practice Address - Street 1:3590 CHEROKEE ST NW
Practice Address - Street 2:STE. 401
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5930
Practice Address - Country:US
Practice Address - Phone:770-218-1166
Practice Address - Fax:770-218-1006
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006254111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGDFMedicare ID - Type Unspecified
GAU82659Medicare UPIN