Healthcare Provider Details

I. General information

NPI: 1164266458
Provider Name (Legal Business Name): TIMOTHY GROSS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 ROSWELL RD
MARIETTA GA
30062-3667
US

IV. Provider business mailing address

1651 MILFORD CREEK OVERLOOK SW
MARIETTA GA
30008-8108
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-2056
  • Fax: 770-794-3038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: