Locust Grove Clinic, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIROO6323 Issued in GA

Legal business name

LOCUST GROVE CLINIC, P.C.

Practice address

2648 Highway 42
Locust Grove, GA 30248-2519

Phone

(770) 898-0028

Fax

(770) 898-7987

NPI assigned

Oct 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Peter J Tully, D.C.NPI 1770659161

Title

Pres

Phone

(770) 898-0028

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter James Tully, D.C.

  • Chiropractor
  • Locust Grove, GA
  • NPI 1770659161
  Medicare reassignment Care Compare group NPD Authorized official
• Elizabeth Catherine Tully, DC

  • Chiropractor
  • Locust Grove, GA
  • NPI 1568568491
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1699964171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2648 HIGHWAY 42",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482519",
            "telephone_number": "770-898-0028",
            "fax_number": "770-898-7987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2648 HIGHWAY 42",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482519",
            "telephone_number": "770-898-0028",
            "fax_number": "770-898-7987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCUST GROVE CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "TULLY",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "770-898-0028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIROO6323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GRP4337",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arless Richey Lewis, LPC
• Candace Lewis, PA-C
• Lacreia Lewis
• Tishawna Charee Lewis, LMFT
• Wesley Todd Livingston
• Locust Grove Endo Center
• Locust Grove Family Medicine
• Locust Grove Pediatrics
• Jovan Antranatte Lovelace
• Camille Lundi, NP-C

• Chiropractor in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.