Provider Demographics
NPI:1215074455
Name:HAWES, ROGER CHARLTON (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLTON
Last Name:HAWES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2151 FOUNTAIN DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6783
Mailing Address - Country:US
Mailing Address - Phone:770-972-4408
Mailing Address - Fax:770-972-6873
Practice Address - Street 1:2151 FOUNTAIN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6783
Practice Address - Country:US
Practice Address - Phone:770-972-4408
Practice Address - Fax:770-972-6873
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR000632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor