Provider Demographics
NPI:1578833786
Name:ATLAS CHIROPRACTIC & WELNESS CENTER, LLC
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC & WELNESS CENTER, LLC
Other - Org Name:HOMER FAMILY CHIROPRACTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K. ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERATI
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:706-677-1010
Mailing Address - Street 1:1253 HISTORIC HOMER HWY
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:GA
Mailing Address - Zip Code:30547-2738
Mailing Address - Country:US
Mailing Address - Phone:706-677-1010
Mailing Address - Fax:706-677-1010
Practice Address - Street 1:1253 HISTORIC HOMER HWY
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-2738
Practice Address - Country:US
Practice Address - Phone:706-677-1010
Practice Address - Fax:706-677-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700383Medicare PIN