Healthcare Provider Details

I. General information

NPI: 1851985147
Provider Name (Legal Business Name): ALISHA GAULDEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 WHITLOCK AVE SW APT 1309
MARIETTA GA
30064-1979
US

IV. Provider business mailing address

1000 WHITLOCK AVE NW STE 320
MARIETTA GA
30064-5449
US

V. Phone/Fax

Practice location:
  • Phone: 504-345-7231
  • Fax:
Mailing address:
  • Phone: 504-345-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHRI010425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: