Provider Demographics
NPI:1093340929
Name:ABRAMS, SHARELL (LMT)
Entity Type:Individual
Prefix:
First Name:SHARELL
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 HIGHLAND PARC PL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-2437
Mailing Address - Country:US
Mailing Address - Phone:404-491-0525
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 330K
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7434
Practice Address - Country:US
Practice Address - Phone:404-491-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty