Provider Demographics
NPI:1235230954
Name:ELLIOTT, WILLIAM KERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KERRY
Last Name:ELLIOTT
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 1:34 GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2602
Mailing Address - Country:US
Mailing Address - Phone:770-253-2073
Mailing Address - Fax:770-251-4202
Practice Address - Street 1:34 GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2602
Practice Address - Country:US
Practice Address - Phone:770-253-2073
Practice Address - Fax:770-251-4202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001771111N00000X
ALLIC 0981-I111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00703282AMedicaid
GA35ZCDNMOtherPIN MEDICARE
GA35ZCDNMOtherPIN MEDICARE