Provider Demographics
NPI:1750686010
Name:GATES, JERRY W (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:GATES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:W
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:809 CLEVELAND SWAVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7108
Mailing Address - Country:US
Mailing Address - Phone:404-748-1850
Mailing Address - Fax:678-515-0164
Practice Address - Street 1:809 CLEVELAND SWAVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7108
Practice Address - Country:US
Practice Address - Phone:404-748-1859
Practice Address - Fax:678-515-0164
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor