Provider Demographics
NPI:1215966197
Name:CAROL ANTONINO DC
Entity type:Organization
Organization Name:CAROL ANTONINO DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-623-3050
Mailing Address - Street 1:4390 PLEASANT HILL RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8054
Mailing Address - Country:US
Mailing Address - Phone:770-623-3050
Mailing Address - Fax:
Practice Address - Street 1:4390 PLEASANT HILL RD
Practice Address - Street 2:SUITE G
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8054
Practice Address - Country:US
Practice Address - Phone:770-623-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCCQBMedicare UPIN