Provider Demographics
NPI:1477011898
Name:MAYO, KRISTIN RENEE (DC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:MAYO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2509
Mailing Address - Country:US
Mailing Address - Phone:770-833-8845
Mailing Address - Fax:
Practice Address - Street 1:750 MT ZION RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3817
Practice Address - Country:US
Practice Address - Phone:770-968-5611
Practice Address - Fax:770-968-5468
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO010120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor