Provider Demographics
NPI:1811389430
Name:HASTY, JOSHUA (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HASTY
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 1:2615 PEACHTREE PKWY
Mailing Address - Street 2:270
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1022
Mailing Address - Country:US
Mailing Address - Phone:770-595-7431
Mailing Address - Fax:
Practice Address - Street 1:2615 PEACHTREE PKWY
Practice Address - Street 2:270
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1022
Practice Address - Country:US
Practice Address - Phone:770-595-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor