Provider Demographics
NPI:1548322340
Name:KONDYLES, ANDREW N (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:N
Last Name:KONDYLES
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 1:614 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2432
Mailing Address - Country:US
Mailing Address - Phone:770-684-1024
Mailing Address - Fax:770-684-1026
Practice Address - Street 1:614 E ELM ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2432
Practice Address - Country:US
Practice Address - Phone:770-684-1024
Practice Address - Fax:770-684-1026
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07193Medicare UPIN
GA35ZCJLBMedicare ID - Type UnspecifiedPROVIDER ID