Individual
DR. TERESA GRACE FOURRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C., CNMT
Contact information
Practice address
4080 HOLLY SPRINGS PKWY, CANTON, GA 30115-7410
(770) 345-7885
(770) 345-7883
Mailing address
PO BOX 489, HOLLY SPRINGS, GA 30142-0009
(770) 345-7885
(770) 345-7883
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIR006079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52726673
BLUE CROSS BLUE SHIELD #
GA
Enumeration date
02/05/2007
Last updated
07/08/2007
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