Provider Demographics
NPI:1619238805
Name:DOUG GILES, DC, LLC
Entity Type:Organization
Organization Name:DOUG GILES, DC, LLC
Other - Org Name:GRAND OAK HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-543-2584
Mailing Address - Street 1:2425 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3415
Mailing Address - Country:US
Mailing Address - Phone:706-543-2584
Mailing Address - Fax:706-354-0702
Practice Address - Street 1:2425 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3415
Practice Address - Country:US
Practice Address - Phone:706-543-2584
Practice Address - Fax:706-354-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7421111N00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty