Provider Demographics
NPI:1649349952
Name:SABOURA, STEFANCHARLES G (DC)
Entity type:Individual
Prefix:DR
First Name:STEFANCHARLES
Middle Name:G
Last Name:SABOURA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:G
Other - Last Name:SABOURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2453 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4570
Mailing Address - Country:US
Mailing Address - Phone:678-567-2313
Mailing Address - Fax:678-567-2259
Practice Address - Street 1:2453 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4570
Practice Address - Country:US
Practice Address - Phone:678-567-2313
Practice Address - Fax:678-567-2259
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFVWMedicare ID - Type Unspecified