Provider Demographics
NPI:1215354501
Name:SOUTH GEORGIA UPPER CERVICAL CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SOUTH GEORGIA UPPER CERVICAL CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:MCWILLIAMS
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-469-4069
Mailing Address - Street 1:2935 N ASHLEY ST
Mailing Address - Street 2:STE 109
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1777
Mailing Address - Country:US
Mailing Address - Phone:229-469-4069
Mailing Address - Fax:229-469-4069
Practice Address - Street 1:2935 N ASHLEY ST
Practice Address - Street 2:STE 109
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1777
Practice Address - Country:US
Practice Address - Phone:229-469-4069
Practice Address - Fax:229-469-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty