Provider Demographics
NPI:1346454576
Name:ERGAS, MITCH E (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCH
Middle Name:E
Last Name:ERGAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:MITCH
Other - Middle Name:
Other - Last Name:ERGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:735 WINDY HILL RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1859
Mailing Address - Country:US
Mailing Address - Phone:770-432-7676
Mailing Address - Fax:770-432-7646
Practice Address - Street 1:735 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1859
Practice Address - Country:US
Practice Address - Phone:770-432-7676
Practice Address - Fax:770-432-7646
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06412111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGTXMedicare ID - Type UnspecifiedCARRIER PROVIDER NUMBER
GAGRP4484Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAU90065Medicare UPIN