Provider Demographics
NPI:1336959303
Name:BURCH, SHARMAIN T
Entity type:Individual
Prefix:
First Name:SHARMAIN
Middle Name:T
Last Name:BURCH
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 1:5525 STUBBEN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1871
Mailing Address - Country:US
Mailing Address - Phone:254-383-8718
Mailing Address - Fax:
Practice Address - Street 1:5525 STUBBEN CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1871
Practice Address - Country:US
Practice Address - Phone:254-383-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY883429088171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor