Provider Demographics
NPI:1598891210
Name:TURNER BOOTH CLINIC
Entity Type:Organization
Organization Name:TURNER BOOTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-944-2300
Mailing Address - Street 1:5575 MABLETON PKWY SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3301
Mailing Address - Country:US
Mailing Address - Phone:770-944-2300
Mailing Address - Fax:770-944-7861
Practice Address - Street 1:5575 MABLETON PKWY SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3301
Practice Address - Country:US
Practice Address - Phone:770-944-2300
Practice Address - Fax:770-944-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBWBMedicare ID - Type Unspecified
GAU25698Medicare UPIN