Healthcare Provider Details

I. General information

NPI: 1700044179
Provider Name (Legal Business Name): NOVA A. GRANDE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 PEACHTREE PKWY STE 230
CUMMING GA
30041-7235
US

IV. Provider business mailing address

415 PEACHTREE PKWY STE 230
CUMMING GA
30041-7235
US

V. Phone/Fax

Practice location:
  • Phone: 678-947-3316
  • Fax:
Mailing address:
  • Phone: 678-947-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIR008276
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: