Provider Demographics
NPI:1669582599
Name:LOGGINS, SHARON MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MARIE
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:DEFRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:909 SENOIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-6805
Mailing Address - Country:US
Mailing Address - Phone:770-225-2426
Mailing Address - Fax:678-550-9057
Practice Address - Street 1:909 SENOIA RD STE A
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-6805
Practice Address - Country:US
Practice Address - Phone:770-225-2426
Practice Address - Fax:678-550-9057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9057111N00000X
GACHIR009489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN:46304ZOtherMEDICARE