Provider Demographics
NPI:1023152949
Name:PAULK CHIROPRACTIC-MCDONOUGH INC.
Entity type:Organization
Organization Name:PAULK CHIROPRACTIC-MCDONOUGH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-583-2982
Mailing Address - Street 1:416 HIGHWAY 155 S
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6623
Mailing Address - Country:US
Mailing Address - Phone:678-583-2982
Mailing Address - Fax:678-583-2983
Practice Address - Street 1:9905 N DAVIDSON PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4200
Practice Address - Country:US
Practice Address - Phone:770-474-1421
Practice Address - Fax:770-474-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty