Healthcare Provider Details

I. General information

NPI: 1942317102
Provider Name (Legal Business Name): KATHLEEN MARIE SHERWOOD DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
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 Number05269
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: