Provider Demographics
NPI:1619054707
Name:HYATT, CHAD AVERY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:AVERY
Last Name:HYATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HORIZON PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7250
Mailing Address - Country:US
Mailing Address - Phone:770-237-3300
Mailing Address - Fax:770-904-3785
Practice Address - Street 1:2950 HORIZON PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7250
Practice Address - Country:US
Practice Address - Phone:770-237-3300
Practice Address - Fax:770-904-3785
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFRTMedicare ID - Type Unspecified