Provider Demographics
NPI:1770770992
Name:GRADDY, SHARON (DC)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:GRADDY
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 1:2265 ROSWELL RD
Mailing Address - Street 2:100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2997
Mailing Address - Country:US
Mailing Address - Phone:770-509-2200
Mailing Address - Fax:770-509-2231
Practice Address - Street 1:2265 ROSWELL RD
Practice Address - Street 2:100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2997
Practice Address - Country:US
Practice Address - Phone:770-509-2200
Practice Address - Fax:770-509-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007645111NN1001X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician