Provider Demographics
NPI:1124245667
Name:HYATT FAMILY CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:HYATT FAMILY CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-237-3300
Mailing Address - Street 1:105 SATELLITE BLVD NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7149
Mailing Address - Country:US
Mailing Address - Phone:770-237-3300
Mailing Address - Fax:770-237-3139
Practice Address - Street 1:105 SATELLITE BLVD NW
Practice Address - Street 2:SUITE D
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7149
Practice Address - Country:US
Practice Address - Phone:770-237-3300
Practice Address - Fax:770-237-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5693111N00000X
GA6040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFRTMedicare ID - Type Unspecified