Healthcare Provider Details

I. General information

NPI: 1346023512
Provider Name (Legal Business Name): SPINEALIGN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CARNEGIE PL STE 106
FAYETTEVILLE GA
30214-7911
US

IV. Provider business mailing address

140 CARNEGIE PL STE 106
FAYETTEVILLE GA
30214-7911
US

V. Phone/Fax

Practice location:
  • Phone: 678-489-2974
  • Fax:
Mailing address:
  • Phone: 404-455-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERRA MAELETTE BRYANT
Title or Position: OWNER
Credential: DC
Phone: 404-455-3654