Provider Demographics
NPI:1346829421
Name:KRISHNAPPAN, SHARADHA (DPM)
Entity type:Individual
Prefix:
First Name:SHARADHA
Middle Name:
Last Name:KRISHNAPPAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COBB PKWY SE APT 2508
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7757
Mailing Address - Country:US
Mailing Address - Phone:678-978-5974
Mailing Address - Fax:
Practice Address - Street 1:100 MARKET PLACE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8717
Practice Address - Country:US
Practice Address - Phone:470-790-2008
Practice Address - Fax:470-315-1517
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.001139213ES0103X
GAPOD305033213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery