Provider Demographics
NPI:1306507546
Name:TERRY, SHARON (RISGERTERED NURSE)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:RISGERTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 BULLSBORO DR # 174
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1069
Mailing Address - Country:US
Mailing Address - Phone:678-910-6888
Mailing Address - Fax:
Practice Address - Street 1:19 PERRY ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1918
Practice Address - Country:US
Practice Address - Phone:678-910-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA825143606OtherTRICARE
GA825143606Medicaid