Healthcare Provider Details

I. General information

NPI: 1770770992
Provider Name (Legal Business Name): SHARON GRADDY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 ROSWELL RD 100
MARIETTA GA
30062-2997
US

IV. Provider business mailing address

2265 ROSWELL RD 100
MARIETTA GA
30062-2997
US

V. Phone/Fax

Practice location:
  • Phone: 770-509-2200
  • Fax: 770-509-2231
Mailing address:
  • Phone: 770-509-2200
  • Fax: 770-509-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number007645
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number007645
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number007645
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: