Provider Demographics
NPI:1992923973
Name:DR J MYRA SARGENT DC PC
Entity type:Organization
Organization Name:DR J MYRA SARGENT DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:MYRA
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:404-765-0021
Mailing Address - Street 1:4203 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:404-765-0021
Mailing Address - Fax:404-765-0323
Practice Address - Street 1:1380 CLEVELAND AVENUE
Practice Address - Street 2:MAIN STREET CLINIC
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6959
Practice Address - Country:US
Practice Address - Phone:404-765-0021
Practice Address - Fax:404-765-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty