Provider Demographics
NPI:1790028314
Name:GEORGIA HEALTH GROUP
Entity Type:Organization
Organization Name:GEORGIA HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-379-0943
Mailing Address - Street 1:125 EAGLE SPRING DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6328
Mailing Address - Country:US
Mailing Address - Phone:678-379-0943
Mailing Address - Fax:678-379-0945
Practice Address - Street 1:125 EAGLE SPRING DR
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6328
Practice Address - Country:US
Practice Address - Phone:678-379-0943
Practice Address - Fax:678-379-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty