Tristar Injury Center of Douglasville LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

TRISTAR INJURY CENTER OF DOUGLASVILLE LLC

Practice address

5977 Stewart Pkwy
Douglasville, GA 30135-2371

Phone

(770) 942-5575

NPI assigned

Feb 1, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Alex Jutis, DC

Title

Ceo

Phone

(678) 730-6240

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1861198970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3441 LAWRENCEVILLE SUWANEE RD STE C",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246503",
            "telephone_number": "678-730-6240",
            "fax_number": "678-730-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5977 STEWART PKWY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301352371",
            "telephone_number": "770-942-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTAR INJURY CENTER OF DOUGLASVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "JUTIS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-730-6240",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.