Healthcare Provider Details

I. General information

NPI: 1205981925
Provider Name (Legal Business Name): SHARON LAMBERT RILEY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 GREEN ST NE STE. 2
GAINESVILLE GA
30501-3354
US

IV. Provider business mailing address

1036 ETTA VESTA CIR
GAINESVILLE GA
30501-1154
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-0143
  • Fax:
Mailing address:
  • Phone: 770-534-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5112
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: