MEDICARE: DR. SHERYONA LAPATRICE GREEN-OWUSU DC

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	111N00000X	Chiropractor	CHIR010835	GA

General Provider Information

NPI Number	:	1508570839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERYONA LAPATRICE GREEN-OWUSU DC

Provider Business Mailing Address
First Line	:	3035 WATSON BLVD STE 5
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-9527
Country	:	US
Telephone Number	:	478-333-6134
Fax Number	:	478-333-6138

Provider Business Practice Location Address
First Line	:	2169 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2029
Country	:	US
Telephone Number	:	478-474-2344
Fax Number	:

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

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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