Provider Demographics
NPI:1831955889
Name:NEXGEN CHIROPRACTIC AND NEUROLOGY
Entity type:Organization
Organization Name:NEXGEN CHIROPRACTIC AND NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAWZIYYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIBCN
Authorized Official - Phone:772-971-9602
Mailing Address - Street 1:114 NEWRY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8112
Mailing Address - Country:US
Mailing Address - Phone:772-971-9602
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE FORREST DR STE 115
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3835
Practice Address - Country:US
Practice Address - Phone:772-971-9602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty