Healthcare Provider Details

I. General information

NPI: 1003097767
Provider Name (Legal Business Name): SHERWOOD CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 MCCONNELL DR SUITE E
DECATUR GA
30033-3505
US

IV. Provider business mailing address

1275 MCCONNELL DR SUITE E
DECATUR GA
30033-3505
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-0082
  • Fax: 404-321-2007
Mailing address:
  • Phone: 404-321-0082
  • Fax: 404-321-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO05269
License Number StateGA

VIII. Authorized Official

Name: MARILYN DENISE THOMAS
Title or Position: INSURANCE EXPERT
Credential:
Phone: 404-321-6997