Provider Demographics
NPI:1366457103
Name:SURMA, DARREN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:MICHAEL
Last Name:SURMA
Suffix:
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 1:511 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8857
Mailing Address - Country:US
Mailing Address - Phone:770-853-1943
Mailing Address - Fax:
Practice Address - Street 1:1000 WOODSTOCK PKWY
Practice Address - Street 2:SUITE #160
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4856
Practice Address - Country:US
Practice Address - Phone:678-388-7788
Practice Address - Fax:678-880-6617
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2015-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHWMMedicare PIN
V01764Medicare UPIN