Provider Demographics
NPI:1750736732
Name:GRD CLINIC, PC
Entity type:Organization
Organization Name:GRD CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURUSAHAY
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-551-0155
Mailing Address - Street 1:1845 PEELER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5710
Mailing Address - Country:US
Mailing Address - Phone:770-551-0155
Mailing Address - Fax:770-551-0152
Practice Address - Street 1:1845 PEELER RD
Practice Address - Street 2:SUITE A
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5710
Practice Address - Country:US
Practice Address - Phone:770-551-0155
Practice Address - Fax:770-551-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty