Provider Demographics
NPI:1679278535
Name:CEJA, MARIA
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:CEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8969
Mailing Address - Country:US
Mailing Address - Phone:817-212-9881
Mailing Address - Fax:
Practice Address - Street 1:4850 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2859
Practice Address - Country:US
Practice Address - Phone:404-474-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010929111N00000X
GACHIRO10929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor