Provider Demographics
NPI:1457678682
Name:BACKSMART HEALTH LLC - NORTH GA DIAGNOSTIC & REHAB
Entity Type:Organization
Organization Name:BACKSMART HEALTH LLC - NORTH GA DIAGNOSTIC & REHAB
Other - Org Name:NORTH GA DIAGNOSTIC & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-888-4288
Mailing Address - Street 1:5485 BETHELVIEW RD STE 360-225
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9735
Mailing Address - Country:US
Mailing Address - Phone:770-888-4288
Mailing Address - Fax:678-947-3203
Practice Address - Street 1:5485 BETHELVIEW RD STE 360-225
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9735
Practice Address - Country:US
Practice Address - Phone:770-888-4288
Practice Address - Fax:678-947-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty