Provider Demographics
NPI:1982664009
Name:MAYO, VIRGINIA SUSAN (DC)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:SUSAN
Last Name:MAYO
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 1:2840 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3156
Mailing Address - Country:US
Mailing Address - Phone:770-985-9022
Mailing Address - Fax:770-985-9021
Practice Address - Street 1:2840 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3156
Practice Address - Country:US
Practice Address - Phone:770-985-9022
Practice Address - Fax:770-985-9021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97737Medicare UPIN