Provider Demographics
NPI:1205389574
Name:ANTOINE, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 TERRELL MILL RD SE
Mailing Address - Street 2:2C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8460
Mailing Address - Country:US
Mailing Address - Phone:407-952-7309
Mailing Address - Fax:
Practice Address - Street 1:130 ALLEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4944
Practice Address - Country:US
Practice Address - Phone:407-952-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009744111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation