Provider Demographics
NPI:1700044179
Name:GRANDE, NOVA A (DC)
Entity Type:Individual
Prefix:DR
First Name:NOVA
Middle Name:A
Last Name:GRANDE
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 1:415 PEACHTREE PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7235
Mailing Address - Country:US
Mailing Address - Phone:678-947-3316
Mailing Address - Fax:
Practice Address - Street 1:415 PEACHTREE PKWY STE 230
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7235
Practice Address - Country:US
Practice Address - Phone:678-947-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008276111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487830253OtherNPI GROUP #
GA11-3814304OtherIRS EIN#