Provider Demographics
NPI:1740553858
Name:JARED R SIMON, PC
Entity type:Organization
Organization Name:JARED R SIMON, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-634-1669
Mailing Address - Street 1:1758 CENTURY BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3392
Mailing Address - Country:US
Mailing Address - Phone:404-634-1669
Mailing Address - Fax:404-634-1442
Practice Address - Street 1:1758 CENTURY BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3392
Practice Address - Country:US
Practice Address - Phone:404-634-1669
Practice Address - Fax:404-634-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO5019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU51092Medicare UPIN