Provider Demographics
NPI:1063923936
Name:RICHARDS, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 MICHAEL CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8470
Mailing Address - Country:US
Mailing Address - Phone:678-887-7413
Mailing Address - Fax:770-267-9838
Practice Address - Street 1:667 MICHAEL CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8470
Practice Address - Country:US
Practice Address - Phone:678-887-7413
Practice Address - Fax:770-267-9838
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147-R-1050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health