Provider Demographics
NPI:1386067114
Name:GEORGIA TOTAL CARE, LLC
Entity type:Organization
Organization Name:GEORGIA TOTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTELDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-495-1212
Mailing Address - Street 1:4731 W ATLANTIC AVE
Mailing Address - Street 2:B-21
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3897
Mailing Address - Country:US
Mailing Address - Phone:561-495-1212
Mailing Address - Fax:561-495-1214
Practice Address - Street 1:1000 WHITLOCK AVE NW
Practice Address - Street 2:340
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5455
Practice Address - Country:US
Practice Address - Phone:561-495-1212
Practice Address - Fax:561-495-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty