Healthcare Provider Details

I. General information

NPI: 1346829421
Provider Name (Legal Business Name): SHARADHA KRISHNAPPAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARKET PLACE BLVD STE 302
CARTERSVILLE GA
30121-8717
US

IV. Provider business mailing address

2100 COBB PKWY SE APT 2508
SMYRNA GA
30080-7757
US

V. Phone/Fax

Practice location:
  • Phone: 470-790-2008
  • Fax: 470-315-1517
Mailing address:
  • Phone: 678-978-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135.001139
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD305033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: