# PERFORMANCE SPORT AND SPINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841798279
- **Authorized official:** DR. TIMOTHY MICHAEL GREGORY DC (CHRIOPRACTOR/OWNER)
- **Authorized official phone:** (404) 721-4406

## Contact information

- **Practice address:** 1575 OLD ALABAMA RD STE 105, ROSWELL, GA 30076-2133
- **Practice address phone:** (404) 721-4406
- **Practice address fax:** (404) 601-5101
- **Mailing address:** 1575 OLD ALABAMA RD STE 105, ROSWELL, GA 30076-2133
- **Mailing address phone:** (404) 721-4406
- **Mailing address fax:** (404) 601-5101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | CHIR005801 | GA | Yes |

## Other

- **Enumeration date:** 01/31/2018
- **Last updated:** 01/31/2018