Provider Demographics
NPI:1538216924
Name:DE CARLO, RICHARD JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:DE CARLO
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 1:4686 S ATLANTA RD SE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7080
Mailing Address - Country:US
Mailing Address - Phone:404-794-4357
Mailing Address - Fax:404-794-8205
Practice Address - Street 1:4686 S ATLANTA RD SE
Practice Address - Street 2:SUITE G
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7080
Practice Address - Country:US
Practice Address - Phone:404-794-4357
Practice Address - Fax:404-794-8205
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4813111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFPDMedicare ID - Type Unspecified