Provider Demographics
NPI:1265828628
Name:GEORGIA UPPER CERVICAL LLC
Entity Type:Organization
Organization Name:GEORGIA UPPER CERVICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-882-3323
Mailing Address - Street 1:4499 HIGHWAY 40 STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9402
Mailing Address - Country:US
Mailing Address - Phone:912-882-3323
Mailing Address - Fax:912-673-7573
Practice Address - Street 1:4499 HIGHWAY 40 STE C
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-9402
Practice Address - Country:US
Practice Address - Phone:912-882-3323
Practice Address - Fax:912-673-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty