Provider Demographics
NPI:1699843870
Name:FLETCHER, PERI MICHELLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:PERI
Middle Name:MICHELLE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 A BASCOMB COMM PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-924-9400
Mailing Address - Fax:770-924-3100
Practice Address - Street 1:715 A BASCOMB COMM PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-924-9400
Practice Address - Fax:770-924-3100
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJ6VMedicare ID - Type Unspecified
V05772Medicare UPIN