Provider Demographics
NPI:1982983144
Name:PRADOS, GONZALO MANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:MANUEL
Last Name:PRADOS
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 1:250 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4242
Mailing Address - Country:US
Mailing Address - Phone:404-966-3477
Mailing Address - Fax:
Practice Address - Street 1:3369 BUFORD HWY NE
Practice Address - Street 2:SUITE 830 B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3722
Practice Address - Country:US
Practice Address - Phone:404-966-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor