MEDICARE: KORRIE SPARROW CD,DONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	374J00000X	Doula

General Provider Information

NPI Number	:	1306592142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORRIE SPARROW CD,DONA

Provider Business Mailing Address
First Line	:	1508 STATION CLUB DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7514
Country	:	US
Telephone Number	:	386-682-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 FELTON DR STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-3603
Country	:	US
Telephone Number	:	386-682-1809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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