Active NPI
Esther Widjaja
- Chiropractor
- Peachtree Corners, GA
National Provider Identifier
1124511902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIR010066
- Practice address
- 6050 Peachtree Pkwy Ste 420
Peachtree Corners, GA 30092-3362 - Phone
- (770) 744-5810
- NPI assigned
- Jun 7, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIR010066 | GA | Primary |
Addresses
Primary practice location
6050 Peachtree Pkwy Ste 420
Peachtree Corners, GA 30092-3362
Mailing address
6050 Peachtree Pkwy Ste 420
Peachtree Corners, GA 30092-3362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIR010066 | GA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1124511902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6050 PEACHTREE PKWY STE 420",
"city": "PEACHTREE CORNERS",
"state": "GA",
"postal_code": "300923362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6050 PEACHTREE PKWY STE 420",
"city": "PEACHTREE CORNERS",
"state": "GA",
"postal_code": "300923362",
"telephone_number": "770-744-5810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDJAJA",
"first_name": "ESTHER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-07",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "GA",
"license": "CHIR010066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peachtree Corners, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.