Provider Demographics
NPI:1437212388
Name:GORMAN, SHARON R (DC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:GORMAN
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 1:593 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4454
Mailing Address - Country:US
Mailing Address - Phone:770-993-8888
Mailing Address - Fax:770-993-7800
Practice Address - Street 1:593 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4454
Practice Address - Country:US
Practice Address - Phone:770-993-8888
Practice Address - Fax:770-993-7800
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002838L111N00000X
GACHIR007698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA076876OtherPTAN
114185Medicare UPIN