Provider Demographics
NPI:1891199543
Name:HART, WILLIAM LOGAN (BS, DC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LOGAN
Last Name:HART
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 HIGHWAY 54
Mailing Address - Street 2:DYNAMIC SPINE CENTER
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269
Mailing Address - Country:US
Mailing Address - Phone:770-876-2229
Mailing Address - Fax:
Practice Address - Street 1:2836 HIGHWAY 54
Practice Address - Street 2:DYNAMIC SPINE CENTER
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:770-876-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009394111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician