Provider Demographics
NPI:1790063287
Name:MEADOWS, CARMEN A (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 SIXES RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8953
Mailing Address - Country:US
Mailing Address - Phone:678-485-1923
Mailing Address - Fax:770-926-6899
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR
Practice Address - Street 2:SUITE 330
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8200
Practice Address - Country:US
Practice Address - Phone:678-485-1923
Practice Address - Fax:770-926-6899
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I356421OtherMEDICARE