1174685325 NPI number — FRIENDSHIP FAMILY CHIROPRACTIC GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174685325 NPI number — FRIENDSHIP FAMILY CHIROPRACTIC GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDSHIP FAMILY CHIROPRACTIC GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174685325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327 DAHLONEGA ST
Provider Second Line Business Mailing Address:
SUITE 1801B
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30040-2480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-205-8433
Provider Business Mailing Address Fax Number:
770-205-7793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 DAHLONEGA ST
Provider Second Line Business Practice Location Address:
SUITE 1801B
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30040-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-205-8433
Provider Business Practice Location Address Fax Number:
770-205-7793
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEMPSEY
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
ENGLAND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-205-8433

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR006513 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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