Provider Demographics
NPI:1598782286
Name:VILLAGE HEALTH GEORGIA, P.C.
Entity Type:Organization
Organization Name:VILLAGE HEALTH GEORGIA, P.C.
Other - Org Name:VILLAGE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCKENTLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-444-9191
Mailing Address - Street 1:4425 S COBB DR SE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6368
Mailing Address - Country:US
Mailing Address - Phone:770-444-9191
Mailing Address - Fax:770-444-9391
Practice Address - Street 1:4425 S COBB DR SE
Practice Address - Street 2:SUITE G
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6368
Practice Address - Country:US
Practice Address - Phone:770-444-9191
Practice Address - Fax:770-444-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty