Provider Demographics
NPI:1437167418
Name:PHAM, EDWARD DUY (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DUY
Last Name:PHAM
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 1:110 EVANS MILL DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1623
Mailing Address - Country:US
Mailing Address - Phone:678-363-3444
Mailing Address - Fax:678-363-3441
Practice Address - Street 1:110 EVANS MILL DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1623
Practice Address - Country:US
Practice Address - Phone:678-363-3444
Practice Address - Fax:678-363-3441
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHTBMedicare ID - Type Unspecified
U95928Medicare UPIN