Individual
DR. BETHANY PROVENCIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1709 MOUNT VERNON RD STE C, DUNWOODY, GA 30338-4267
(706) 968-7179
Mailing address
1709 MOUNT VERNON RD STE C, DUNWOODY, GA 30338-4267
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR011404
GA
Other
Enumeration date
07/30/2025
Last updated
07/30/2025
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