Healthcare Provider Details

I. General information

NPI: 1013922129
Provider Name (Legal Business Name): JANNA GRESHAM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OLIVER OVERLOOK
DALLAS GA
30132-0437
US

IV. Provider business mailing address

40 OLIVER OVERLOOK
DALLAS GA
30132-0437
US

V. Phone/Fax

Practice location:
  • Phone: 270-572-1451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: