Provider Demographics
NPI:1679264071
Name:BREWER, JIMMY ALEXANDER (DC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:ALEXANDER
Last Name:BREWER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 CHERRYFIELD RUN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4502
Mailing Address - Country:US
Mailing Address - Phone:985-688-8909
Mailing Address - Fax:
Practice Address - Street 1:9950 JONES BRIDGE RD STE 600
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-6576
Practice Address - Country:US
Practice Address - Phone:770-754-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor