Provider Demographics
NPI:1356635023
Name:CARLISLE, NICHOLAS DWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DWAYNE
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10945 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 401-160
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8164
Mailing Address - Country:US
Mailing Address - Phone:404-316-1190
Mailing Address - Fax:404-420-2939
Practice Address - Street 1:5009 ROSWELL RD STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2205
Practice Address - Country:US
Practice Address - Phone:404-264-9553
Practice Address - Fax:404-420-2939
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor