Provider Demographics
NPI:1548416605
Name:CARDWELL, BICKERTON WINSTON III (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:BICKERTON
Middle Name:WINSTON
Last Name:CARDWELL
Suffix:III
Gender:M
Credentials:ND, LAC
Other - Prefix:DR
Other - First Name:WINSTON
Other - Middle Name:
Other - Last Name:CARDWELL
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:ND, MS, LAC
Mailing Address - Street 1:45 WEST CROSSVILLE ROAD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:770-594-1233
Mailing Address - Fax:770-594-0037
Practice Address - Street 1:45 W CROSSVILLE RD STE 501
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:770-594-1233
Practice Address - Fax:770-594-0037
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1434175F00000X
GA198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1434OtherNATUROPATHIC PHYSICIAN