Provider Demographics
NPI:1225134711
Name:PURVIS, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:PURVIS
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 1:3284 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1158
Mailing Address - Country:US
Mailing Address - Phone:404-761-6200
Mailing Address - Fax:404-761-0825
Practice Address - Street 1:3284 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1158
Practice Address - Country:US
Practice Address - Phone:404-761-6200
Practice Address - Fax:404-761-0825
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0007051787OtherAETNA
GA935699OtherBLUE CROSS BLUE SHIELD
GA35ZCGPNMedicare ID - Type UnspecifiedMEDICARE