Provider Demographics
NPI:1710238407
Name:SUGAR HILL SPINE AND WELLNESS
Entity Type:Organization
Organization Name:SUGAR HILL SPINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-482-4400
Mailing Address - Street 1:5715 CUMMING HWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5686
Mailing Address - Country:US
Mailing Address - Phone:678-482-4400
Mailing Address - Fax:678-482-4100
Practice Address - Street 1:5715 CUMMING HWY
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5686
Practice Address - Country:US
Practice Address - Phone:678-482-4400
Practice Address - Fax:678-482-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06478111N00000X
GA141041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty