Provider Demographics
NPI:1063406502
Name:SHARON, ZEEV (MD)
Entity type:Individual
Prefix:DR
First Name:ZEEV
Middle Name:
Last Name:SHARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 WINN WAY
Mailing Address - Street 2:SUITE A-210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1712
Mailing Address - Country:US
Mailing Address - Phone:404-294-7033
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:497 WINN WAY
Practice Address - Street 2:SUITE A-210
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1712
Practice Address - Country:US
Practice Address - Phone:404-294-7033
Practice Address - Fax:404-296-4661
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25668174400000X
GA025668207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000274909AMedicaid
GA00274909DMedicaid
GA25668OtherSTATE LICENSE NUMBER
GA00274909AMedicaid
GA00274909AMedicaid
GAC42251Medicare UPIN
GA39BDBTNMedicare ID - Type Unspecified
GA582146852OtherTAX ID NUMBER
GA00274909DMedicaid