Provider Demographics
NPI:1790938181
Name:NESNICK, SHARITY C (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHARITY
Middle Name:C
Last Name:NESNICK
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 1:900 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1600
Mailing Address - Country:US
Mailing Address - Phone:770-516-2323
Mailing Address - Fax:770-516-2219
Practice Address - Street 1:900 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1600
Practice Address - Country:US
Practice Address - Phone:770-516-2323
Practice Address - Fax:770-516-2219
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist