Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIRO10204 | GA |
NPI | 1366002412 |
---|---|
Provider Name | Carla Michelle Marrero-Sanchez |
First Address | Marietta, GA 30067-2922 |
Second Address | Marietta, GA 30062-5023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2019 |
Last Update Date | 19/06/2019 |