Organization
STARTING BLOCK SPORTS MEDICINE & REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY STUART PAUL D.C., A.T.C (PRESIDENT)
(678) 436-5866
Entity
Organization
Contact information
Practice address
105 SMOKE HILL LN, SUITE 120, WOODSTOCK, GA 30188-7364
(678) 436-5866
(678) 262-3677
Mailing address
105 SMOKE HILL LN, SUITE 120, WOODSTOCK, GA 30188-7364
(678) 436-5866
(678) 262-3677
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIRO008613
GA
2251S0007X
Sports Physical Therapist
PT005129
GA
2255A2300X
Athletic Trainer
AT001213
GA
Other
Enumeration date
02/18/2010
Last updated
02/18/2010
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