Basic Information
| Provider Information | |||||||||
| NPI: | 1003989567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AMATO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.C., BCAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 288 HWY 314 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788174053 | ||||||||
| FaxNumber: | 6788174058 | ||||||||
| Practice Location | |||||||||
| Address1: | 288 HWY 314 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788174053 | ||||||||
| FaxNumber: | 6788174058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 10/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CHIR6892 | GA | Y | Chiropractic Providers | Chiropractor |
No ID Information.