Provider Demographics
NPI:1942343165
Name:FANNING, JOSEPH MICHAEL III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:FANNING
Suffix:III
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 1:6385 MCGINNIS FERRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3672
Mailing Address - Country:US
Mailing Address - Phone:770-623-6880
Mailing Address - Fax:770-623-6440
Practice Address - Street 1:6385 MCGINNIS FERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3672
Practice Address - Country:US
Practice Address - Phone:770-623-6880
Practice Address - Fax:770-623-6440
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU75432Medicare UPIN
GA35ZCFPBMedicare ID - Type UnspecifiedMEDICARE