Provider Demographics
NPI:1699870238
Name:PAULK, GEORGE PHILLIP (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PHILLIP
Last Name:PAULK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 DAVIDSON PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-474-1421
Mailing Address - Fax:770-474-3704
Practice Address - Street 1:9905 DAVIDSON PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-474-1421
Practice Address - Fax:770-474-3704
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor