Provider Demographics
NPI:1851434476
Name:SIEGRIST, HARRY ELLSWORTH III (DC, LDO)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ELLSWORTH
Last Name:SIEGRIST
Suffix:III
Gender:M
Credentials:DC, LDO
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Mailing Address - Street 1:4140 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-3067
Mailing Address - Country:US
Mailing Address - Phone:770-941-6063
Mailing Address - Fax:770-739-2020
Practice Address - Street 1:1781 VETERANS MEMORIAL HWY STE 1A
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-7965
Practice Address - Country:US
Practice Address - Phone:770-941-3802
Practice Address - Fax:770-739-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2148111NX0800X
FL4508111NX0800X
WI3452-012111NX0800X
GA645156FX1800X
FL875156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician