Healthcare Provider Details

I. General information

NPI: 1366002412
Provider Name (Legal Business Name): CARLA MICHELLE MARRERO-SANCHEZ DC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 SHALLOWFORD RD STE H6
MARIETTA GA
30062-5023
US

IV. Provider business mailing address

875 FRANKLIN GTWY SE APT 533
MARIETTA GA
30067-2922
US

V. Phone/Fax

Practice location:
  • Phone: 678-352-1948
  • Fax:
Mailing address:
  • Phone: 787-449-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIRO10204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: