Provider Demographics
NPI:1508570839
Name:GREEN-OWUSU, SHERYONA LAPATRICE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERYONA
Middle Name:LAPATRICE
Last Name:GREEN-OWUSU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 WATSON BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-9527
Mailing Address - Country:US
Mailing Address - Phone:478-333-6134
Mailing Address - Fax:478-333-6138
Practice Address - Street 1:2169 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2029
Practice Address - Country:US
Practice Address - Phone:478-474-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor