Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007452 | GA |
NPI | 1003093543 |
---|---|
Provider Name | Ladarian Shawntell Gregory |
First Address | Decatur, GA 30034-1421 |
Second Address | Decatur, GA 30034-1421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 28/01/2008 |