Provider Demographics
NPI:1124747928
Name:PHOENIX, WILLIAM ELORIDGE (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ELORIDGE
Last Name:PHOENIX
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 1:1033 LEGACY OAKS CIR APT 1033
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4838
Mailing Address - Country:US
Mailing Address - Phone:912-657-5232
Mailing Address - Fax:
Practice Address - Street 1:2480 WINDY HILL RD SE STE 104
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8608
Practice Address - Country:US
Practice Address - Phone:770-575-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty