Provider Demographics
NPI:1013090240
Name:PRECOURT, BARTHOLOMEW MICHAEL (DC PC)
Entity Type:Individual
Prefix:DR
First Name:BARTHOLOMEW
Middle Name:MICHAEL
Last Name:PRECOURT
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 PLEDMONT AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3702
Mailing Address - Country:US
Mailing Address - Phone:404-876-0550
Mailing Address - Fax:404-875-4732
Practice Address - Street 1:1014 PIEDMONT AVENUE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:CA
Practice Address - Zip Code:30309-3702
Practice Address - Country:US
Practice Address - Phone:404-876-0550
Practice Address - Fax:404-875-4732
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8927111N00000X
GACHIR006012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA352CFXWMedicare ID - Type Unspecified