Provider Demographics
NPI:1528733946
Name:WITT, OLECIA (DC)
Entity type:Individual
Prefix:DR
First Name:OLECIA
Middle Name:
Last Name:WITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 COUNTRYSIDE PL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8238
Mailing Address - Country:US
Mailing Address - Phone:770-539-2480
Mailing Address - Fax:
Practice Address - Street 1:1016 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1704
Practice Address - Country:US
Practice Address - Phone:770-530-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010584111N00000X
NJ38MC00798700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor