Provider Demographics
NPI:1255480547
Name:WADDELL, JAMES D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:WADDELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STILLWATER CIR STE C
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3856
Mailing Address - Country:US
Mailing Address - Phone:478-293-4883
Mailing Address - Fax:478-293-4886
Practice Address - Street 1:100 STILLWATER CIR STE C
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3856
Practice Address - Country:US
Practice Address - Phone:478-293-4883
Practice Address - Fax:478-293-4886
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCNJMedicare ID - Type Unspecified