Provider Demographics
NPI:1700035037
Name:HEALTHCHOICE CLINIC OF JOHNS CREEK.L.L.C.
Entity Type:Organization
Organization Name:HEALTHCHOICE CLINIC OF JOHNS CREEK.L.L.C.
Other - Org Name:ATL PAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DIDURO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:404-402-1903
Mailing Address - Street 1:766 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4104
Mailing Address - Country:US
Mailing Address - Phone:404-402-1903
Mailing Address - Fax:678-909-0659
Practice Address - Street 1:4535 WINTERS CHAPEL RD
Practice Address - Street 2:SUITE B
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-2705
Practice Address - Country:US
Practice Address - Phone:678-957-0266
Practice Address - Fax:678-909-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO 5305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty