Provider Demographics
NPI:1750687299
Name:TEDDER, ADAM LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LEE
Last Name:TEDDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8494
Mailing Address - Country:US
Mailing Address - Phone:678-318-2431
Mailing Address - Fax:678-615-2368
Practice Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD STE 290
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8494
Practice Address - Country:US
Practice Address - Phone:678-318-2431
Practice Address - Fax:678-615-2368
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor