Provider Demographics
NPI:1801016779
Name:LAMBERT, SECORA (DC)
Entity Type:Individual
Prefix:DR
First Name:SECORA
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 FLAT SHOALS PKWY
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5040
Mailing Address - Country:US
Mailing Address - Phone:404-328-0771
Mailing Address - Fax:
Practice Address - Street 1:4555 FLAT SHOALS PKWY
Practice Address - Street 2:SUITE 100A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5040
Practice Address - Country:US
Practice Address - Phone:404-328-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07301Medicare UPIN