Provider Demographics
NPI:1891740593
Name:BLOTNER, GREGG MICHAEL II (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MICHAEL
Last Name:BLOTNER
Suffix:II
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 1:3528 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4459
Mailing Address - Country:US
Mailing Address - Phone:770-772-7333
Mailing Address - Fax:770-772-1664
Practice Address - Street 1:3528 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4459
Practice Address - Country:US
Practice Address - Phone:770-772-7333
Practice Address - Fax:770-772-1664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor