Individual provider Active NPI

Carmen A Meadows, B.S., D.C.

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1790063287
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR008847 Issued in GA
Practice address
3750 Palladian Village Dr
Suite 330
Marietta, GA 30066-8200
Phone
(678) 485-1923
Fax
(770) 926-6899
NPI assigned
Aug 1, 2011
Last updated
Apr 13, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR008847 GA Primary

Addresses

Primary practice location

3750 Palladian Village Dr
Suite 330
Marietta, GA 30066-8200

Mailing address

1978 Sixes Rd
Canton, GA 30114-8953
Phone (678) 485-1923

Other identifiers 1

IdentifierTypeStateIssuer
202I356421OtherGAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120105000351 GA Practitioner - Chiropractic 6507032026 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Chiropractic Wellness Center, LLC Chiropractor Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334275200000",
    "number": "1790063287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1978 SIXES RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301148953",
            "telephone_number": "678-485-1923",
            "fax_number": "770-926-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 PALLADIAN VILLAGE DR",
            "address_2": "SUITE 330",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300668200",
            "telephone_number": "678-485-1923",
            "fax_number": "770-926-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEADOWS",
        "first_name": "CARMEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "B.S., D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2012-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "202I356421",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.