Provider Demographics
NPI:1295819209
Name:LITTLE, PERRY PHILEMON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:PHILEMON
Last Name:LITTLE
Suffix:JR
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 1:827 N HAIRSTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3441
Mailing Address - Country:US
Mailing Address - Phone:404-299-0039
Mailing Address - Fax:404-299-3969
Practice Address - Street 1:827 N HAIRSTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3441
Practice Address - Country:US
Practice Address - Phone:404-299-0039
Practice Address - Fax:404-299-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO04999111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00810213AMedicaid
GA00810213AMedicaid
GAU71981Medicare UPIN