Provider Demographics
NPI:1558540153
Name:GEORGIA CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:GEORGIA CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:EMILE
Authorized Official - Last Name:EFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-907-1131
Mailing Address - Street 1:6030 HWY 85
Mailing Address - Street 2:SUITE 242
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-907-1131
Mailing Address - Fax:770-907-1115
Practice Address - Street 1:6030 HWY 85
Practice Address - Street 2:SUITE 242
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-907-1131
Practice Address - Fax:770-907-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCDFSOtherCPN
U59924Medicare UPIN