Provider Demographics
NPI:1104456243
Name:PENNELL, HAYLEY GRACE (DC)
Entity type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:GRACE
Last Name:PENNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:PHILLIP
Other - Last Name:MEGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2121 LAKE PARK DR SE APT G
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8951
Mailing Address - Country:US
Mailing Address - Phone:404-981-0022
Mailing Address - Fax:
Practice Address - Street 1:2121 LAKE PARK DR SE APT G
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8951
Practice Address - Country:US
Practice Address - Phone:404-981-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty