Individual
DR. MICHAEL PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
212 MARTHA AVE NE, ATLANTA, GA 30317-1443
(308) 379-4154
Mailing address
212 MARTHA AVE NE, ATLANTA, GA 30317-1443
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1471
HI
Other
Enumeration date
11/09/2021
Last updated
11/09/2021
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