Provider Demographics
NPI:1356042055
Name:BACKSMART HEALTH LLC - NORTH GA DIAGNOSTIC & REHAB
Entity type:Organization
Organization Name:BACKSMART HEALTH LLC - NORTH GA DIAGNOSTIC & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-888-4288
Mailing Address - Street 1:2650 HOLCOMB BRIDGE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5335
Mailing Address - Country:US
Mailing Address - Phone:770-451-9494
Mailing Address - Fax:
Practice Address - Street 1:2650 HOLCOMB BRIDGE RD STE 140
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5335
Practice Address - Country:US
Practice Address - Phone:770-451-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACKSMART HEALTH LLC - NORTH GA DIAGNOSTIC & REHAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-10
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty