Provider Demographics
NPI:1215246434
Name:SMITH-WELDON, BETTY (DC)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:SMITH-WELDON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2088 IDLEWOOD RD STE 6
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6264
Mailing Address - Country:US
Mailing Address - Phone:045-517-5164
Mailing Address - Fax:800-266-1446
Practice Address - Street 1:2088 IDLEWOOD RD STE 6
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6264
Practice Address - Country:US
Practice Address - Phone:404-551-7516
Practice Address - Fax:800-266-1446
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008595111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty