Provider Demographics
NPI:1255415774
Name:PAUL, ROGER WAYNE (DC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:WAYNE
Last Name:PAUL
Suffix:
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 1:3140 GREYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:678-234-7833
Mailing Address - Fax:
Practice Address - Street 1:4101 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:770-271-5600
Practice Address - Fax:678-482-9570
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002466111N00000X
FLCH5149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor