Healthcare Provider Details

I. General information

NPI: 1205050259
Provider Name (Legal Business Name): CARYN ANN GRZESIAKOWSKI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 FLINT RIVER ROAD SUITE #4
JONESBORO GA
30238
US

IV. Provider business mailing address

PO BOX 1378
FAYETTEVILLE GA
30214
US

V. Phone/Fax

Practice location:
  • Phone: 770-478-6040
  • Fax: 770-478-6061
Mailing address:
  • Phone: 770-478-6040
  • Fax: 770-478-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006958
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: